Haiti Days 3 &4

Day 3

This morning we woke up at 7am, hurried to eat breakfast and drink coffee. Jessica was staying at the house to work in the classroom with midwife students, Megan was going out on the little mobile clinic and Winter and I were headed to the hospital. Winter and I jumped on the back of the moto and were on our way. When we arrived to the hospital you could definitely tell it was no longer the weekend and the hospital was in full swing. The postpartum, post op, antepartum and labor and delivery rooms were all full. Not only do they have MFH students at the hospital but also nursing students, government midwife students and the regular hospital staff. Winter and I were both assigned a translator. She was with Shelley and I was with Isabelle. They are both incredibly smart Haitian women that work full time as translators for MFH. There were too many people in the L&D suite so we started in postpartum. We performed all of the postpartum and newborn assessments for the midwife in charge of the unit. The first woman I did a postpartum assessment on was doing ok. However, when I went to the bedside, I asked my translator where her baby was. The patient told my translator that the baby had died. I did my whole assessment, tried to give her good comfort care, and explained to her what she needed to do to keep her milk from coming in. She was so grateful I talked with her about her milk supply because she did not realize that it would still come in since the baby had died. When I looked around the room some more it became apparent to me just how real death is in Haiti. Out of 10 women in the unit, 3 were without a baby. I asked my translator if any of the babies were in the NICU and she told me that all 3 of the babies had not lived through the labor and delivery process. It was amazing to be able to help the moms with latching their infant and showing them how to properly feed. There is not an option for the moms to not breastfeed here as formula is incredibly expensive and not readily available. The salary for a midwife in Haiti for the year is around $4100 a year. These are well educated men and women. They have way more money then the average person here. It is just amazing how little they have. The women in labor are required to bring everything they use to the hospital for themselves. Sheets, towels, water, clothing for labor, everything. If they don’t bring them… they go without. Labor and delivery was an eye-opening experience. The hospital sometimes does not have running water so infection is everywhere. The trashcans that are used, are used by multiple people and there aren’t trashcan liners in them. Blood and body fluids are everywhere. I can’t imagine working consistently in a place that this is the standard or norm. We had 3 patients today that had twins- none of which knew prior to delivery, a mom delivered at home and came in with eclamptic seizures, a footling breech baby and many others lining the hallways waiting for a table to be ready for them. The doctor decided that a woman needed a c-section, we waited for over an hour and a half and still hadn’t taken her back for the c-section because the one OR was occupied. So she sat in labor and delivery with a baby that was having decelerations. As frustrating as some of the practices here are, it is the way it is and makes me incredibly thankful for US medicine.

We came back to the house around 2pm for lunch. We had a corn meal mixture, beans, and okra and beef. They food here is actually very good and the cooks at the house do a very good job to prepare our meals. After eating and changing, Megan and I were scheduled to go to the Azil feeding center. The Azil is run by 2 nuns, a few staff, and volunteers. They take in children that are malnourished and care for them temporarily until they are back to health. The children are not orphans and the parents are expected to go to the nutrition clinic on Thursdays with the children and visit on Sunday. These poor babies range from newborns to school aged children. They are well cared for but with a lack of staff they do not get much physical touch or love. They are literally fed, given their medicine and placed back in their individual crib. The thing that struck Megan and I most is that the children do not cry. They are almost conditioned not to cry because they know they will not be consoled. When they are sat in a chair, they sit. They do not move unless they are told to. If you put your arms out to them to be picked up, they put their hands in the air and cling to your body the second they have physical contact. It absolutely broke my heart that they don’t know the regular comfort or love. It was amazing to see the malnourishment of so many children in one place. They are skin and bones with the big Buddha bellies. Size wise many of them look to be infants but they are able to walk. It was truly an amazing experience and the few hours we spent there felt like some of the most meaningful hours of my life.

Our time came to leave the feeding center and we got back on our moto and headed back to the house. Megan and I took our wonderful cold shower and spent time on the porch talking and decompressing from the day. Although I have loved my time here, it is emotionally very taxing and we quickly realized it is important to talk about the hard and frustrating things that happen throughout the day. For dinner we had a Haitian “pizza”. It was a breaded crust with onions, tomatoes, and chicken. Again it was very tasty! The internet was working well tonight and I was able to call home to catch up for a while. We are back up on the porch (my favorite place in the house) listening to the sounds of the countryside of Haiti and winding down for the evening. Clinical day 1 is in the books. Manifesting a good night of sleep and a great day tomorrow!

Day 4

This morning was incredibly hard to say the least. We woke up to make coffee and our breakfast. This morning I made a protein shake and it was delicious! I was packing my bag for the day at the hospital when the clinical director, Perrine, walked down the hall and was crying. When we asked what was wrong she told us that she would tell us the whole story later but right now one of the mothers was in ICU dying and was in desperate need of oxygen and the hospital was out. The three other volunteers and myself asked how much it would cost and if we were able to buy her an oxygen tank. They said they would be able to get it in town but it would cost $40. Without hesitation, we went in our bags and pulled out the money for our translator to go into town and purchase an oxygen for the woman. As soon as she came back to the house we got on the motos and went to the hospital to see what we would be able to do there to help. The woman was in the ICU bed and her brother in law was at her bedside. She was unconscious and only responded to some painful stimuli. We were told that she had a massive hemorrhage and was in desperate need of blood, however she was O neg blood type and there wasn’t any available in the hospital. If someone would donate at the hospital then they would be able to exchange that blood in Port Au Prince for O neg blood. Again, Port Au Prince is over 3 hours away and she needed it as fast as we could give it to her. So Megan and I went to the Red Cross and donated blood. The woman who ran the center was so happy we were there and able to donate and called Port Au Prince to tell them that the had a good donation. It was actually the comic relief of the day! We were trying to talk with the woman who was placing our transfusion and she just continually laughed at the faces I was making as I did sign language to her. We both had our blood flowing and there was a Haitian man across the room from us who was also donating. When our bags were almost full Megan looks up and yells “fatigue! Madame fatigue!” points to her feet and wants them up in the air. I looked at her and said, “Uh are you going to pass out?” and she goes, “yup. I’m going down.” I wanted so badly to be able to help her because we were the only ones who spoke English but I still had my massive needle in my arm! I saw our translator walk by out in the waiting room and I yelled to Sheily to come help us. She was able to lay her chair down and get her some water and juice. After she had recovered from her episode she informs us that this has happened before. Before we went back to the hospital we finished juice and put bandaids on our punctures. Apparently, a clot had not formed completely on my arm, and as we started the walk I felt something dripping down my arm. I looked down and blood was running down my entire arms. I ran back into the clinic and showed the nurse my arm and she just yelped! She quickly grabbed me some gauze and we laughed again. I was so grateful for those laughs today.

So here is the story with the mother. Please do not read this if you are squeamish. She was a patient that we saw yesterday at the hospital. She came in for labor and found out that she was having twins. She was so upset when she was told because she had 5 children at home and did not want to have anymore. She labored hard all day. Epidurals are not an option or even available for the woman here. I don’t know if any of the woman even know about them. The doctor came in to check the woman and she was 8cm and the first baby was footling breech, meaning the baby was going to come out feet first. In hospitals in America, this would be automatic c-section. The doctor originally told her she would have to deliver vaginally but eventually the doctor agreed that the woman could have a c-section. However, the OR was busy with another patient and there is only one OR. So she would have to wait and her labor continued to progress as she waited. Yesterday, we went back to the house before any of the patients delivered. Not that we could have done anything to change the outcome but my heart breaks that we weren’t there later in the day. The story we were told was from the midwifes and midwife students that were present in the delivery room and told to us by our translator. When the woman became completely dilated and ready to deliver the doctor decided that he would deliver the twins vaginally. The first baby was born and the second one ended up also being footling breech. Sometimes the cervix regresses in dilation after the first twin in born. I do not know nor can I fathom what went through this doctor’s head. With out the cervix completely dilated or the baby ready to deliver, he pulled the second twin out of the mother, tearing her cervix and pulling out the placenta before it detached from the uterine wall. She was now having a massive hemorrhage. The patient passed out as he tore the second baby out of her body. A midwife went to go get one of the other doctors after trying to stop the man. The other doctor was outraged and took over the care of the woman rushing her to the OR where he performed a total hysterectomy. In Haiti there is no such thing as medical assault, informed consent, patient rights. ALL of these were completely violated. I am trying to wrap my head around how inhumane this woman was treated. As I write this she is still on her death bed. I do not know when her oxygen will run out. She no longer has cardiac monitoring, a pulse ox, or cycling blood pressures, because there is only one machine and young boy was in the ICU after surgery that needed it as well. I do not know if she ever received the blood she desperately needed. And no one knows if or when she will ever wake up. I am angry. So angry. I am here because I want to make a difference and I want to help. I cannot change the circumstances of her delivery but I will fight like hell to do what I can to give her a fighting chance now.

After donating blood we went to check on her babies. Not only did we want to see how they were doing after a traumatic delivery, but I wanted to love on them. Whisper in their ears and sing them a song. I thought their mom would like to know we were doing that for her. They are beautiful. Two perfect little boys with big brown eyes and big juicy lips. You can’t help but melt when you look at these two innocent little humans. Their grandma was taking care of them and needed a lot of newborn education. She was very overwhelmed with the whole situation and that was totally understandable. We went over feeding, cord care, burping, clothing and many other topics. We brought them formula from the house, clothes and blankets. Not only were they not expecting two babies, but they really don’t have the money to even care for one. Her family was incredibly gracious for our help and the supplies we were able to give to them. The hospital was allowing the family to take the infants home tonight. Our translator Sheily was explaining to us that if the mother does not survive, that the two babies will likely die as well. The family is from over an hour from Hinche in a rural village. They have no access to clean water, no money or resources, and all are malnourished. So, although we provided them with food for the babies now, if the mother dies and they go back home there will be nothing to feed the babies. I know this is common in Haiti and I know death is faced all the time in childbirth. But this did not need to happen. It was preventable. And I wish this doctor would be held responsible. But he won’t. There is not a justice system in place for things like this. No medical board to complain to. But if looks could kill he would have dropped dead when he made eye contact with me today. This will take time to process and grieve. I grieve for the woman, her babies, and her family. I grieve for Haiti. And I grieve for the midwifes, students, staff at MFH and the other girls with me. We want to do good for these people. And we do so much good for them. But on days like today it doesn’t seem to matter. We are a small number in a sea of injustices.

This afternoon I took some time for myself. To think, process and breathe. I laid in the hammock on the patio and was still. This is emotionally draining and I made a point to have a little self-care today. Megan and I had a long conversation, pulled up our big girl panties and got back to work. We sorted through all of the donated supplies we brought and inventoried everything for the storage room. It doesn’t sound like a lot but the task is daunting and one less thing the full-time staff has to worry about. Megan and Jessica went on a home visit while Winter and I finished with the supplies. When we were finished we made cord tie packs that can be sterilized and put in delivery packs tomorrow. We took a walk down to the little store on the side of the road and grabbed a Prestige beer. We got one for our gate guard too. Dinner was Haitian “junk food night”. Fried plantains and some sort of fried root and a spicy coleslaw side. After walking back to the store to return the empty beer bottles, Megan and I went back up to our favorite balcony talked some more and listened to the night sounds. The bugs chirping, children laughing and playing in the street outside and all the motos driving by. I am so glad I am here with an amazing staff and 3 wonderful girls. We knew we would be close fast but I know we can all lean on each other, learn from one another, and maybe make a bigger difference then we realize. Off to bed! Tomorrow will be here quickly.