Wednesday, May 22, 2013

Haiti Days 6 and Days 7

Day 6- Tuesday
Woke up early and had breakfast. They prepared eggs with onions and peppers and pineapple. I skipped the eggs because peppers make my throat have issues. I had a piece of bread instead and a Luna bar. Midwifery meeting had me doing prenatals and being available for a birth if it came in with Marie as second. It was a very busy morning.  No labors came in so we just hung around the rest of the afternoon. A lunch of rice and beans and spaghetti for dinner.  We saw about 30 prenatals and 14 postpartums. I slept well outside again.

Below are the native staff midwives. 

Day 7- Wednesday
I woke up at 5 am to rooster crowing and the power was on so I moved to my indoor bed under a fan and slept two more hours.

 Claudin woke me up at 7 to say a labor was here. It was Mediline, the woman who was here last week with false labor and bleeding. We  sent her home with orders for a HIV and syphilis test, these are free, and an ultrasound. She was back with her ultrasound orders, was 4 cm and in labor but still no test results. The ultrasound showed low amniotic fluid, a low reactant and small baby and a mystery as far as where the bleeding came from. Still no test results and she still had syphilitic type sores all over her body. We asked her why she didn't get her tests done and she said she didn't want to.  Marie, Mary, and I discussed all of the options and mostly due to the fact that she was non compliant we  decided to transport her. We started an IV and her friends came to be her support at the hospital. They were really upset that we were taking her but calmed down after we shared the reasons and nodded their head in agreement. They got into the MBH ambulance and headed out.

 Only 18 prenatals this morning.  I saw two interesting cases today. The day I arrived they had just transported a mom in preterm labor at 30 weeks.  She showed up today for her regular prenatal. They gave her some mystery pills to take daily and sent her home. They told her to come back if she needed to push or to come to MBH. She was complaining the mystery pills gave her heart problems. We didn’t know what she was on and so had no advice for her. It was really difficult to not know what to do do help. It made me thankful for being back home where co-care exists and is just a phone call away.  I sent her home with magnesium and calcium for her irritable uterus and told her to come back every week. 

Another mom was breech and engaged at 35 weeks and a transverse baby at 36 weeks. A second time mom came in measuring 47 cm at 40 weeks. Major polyhydraminous confirmed by ultrasound with a small for gestational age baby. We referred her to the hospital for an induction. 

We saw several postpartum moms. 
 A good number of them birth at the hospital or at home but come here for care as neither the hospital or the TBA do postpartum care. I saw two different mothers. The first was there with her 8th child. A beautiful little girl. They were both healthy but I did some cord care. The TBA's and the hospital just tie off the cord, cut them keeping them very long usually between 3 and 6 inches, and stick a piece of cloth to them. They are often stinky and infected from being pulled on and not having enough air circulation after a few days. Traditionally women wrap their baby’s bellies to keep them strong and from having big bellies. They have a fear of large distended abdomens in children as this is a sign of malnutrition. The only real problem it causes is lack of circulation for the umbilical stump and over heating so we try to discourage it.  They also don't use waterproof diaper covers so the babies always feel wet. The second mom had a listless one month old. She said he, although he was dressed in a pink dress, hadn't nursed in over 24 hours. We took mom to a private room and had her strip off her shirt as well as stripping the baby to his diaper. He nursed right away and continued for the next hour. Mom complained that her breasts were too full and she couldn’t get him to nurse in the morning. We talked about nursing 8 to 12 times a day and hand expressing to help the baby latch on. I finally figured out after quite a few discussions that nursing 8-12 times a day means nothing to most people who do not have a watch. So much to my interpreters aggravation I got in the habit of saying
 "Nurse first thing in the morning, nurse after you gather water, nurse after your first meal, nurse after the baby sleeps, nurse before you make another meal, nurse when it is getting dark, nurse when it is completely dark, nurse when you need to get up to pee at night. Repeat, repeat, repeat."
 I think she just wanted formula and felt too tired, hot and sweaty to nurse her baby. I truthfully didn't blame her. It was hot. We asked her to return tomorrow so we could check on him. We were done early around noon. Martha and I have gotten pretty good at working together and sharing an interpreter. In the afternoon we walked to the gas station for snacks. This bottle of vodka cost half as much as a Snickers bar. Made me chuckle.

 I got chocolate of course, two snickers bars. I put one in the freezer and it disappeared. I was pretty sure it was one of the workers children who took it. I didn't make a big deal about it because really I didn't need two Snickers bars and that child really did. When I was at MBH the only thefts that had occurred were food. Laptops and Ipods lying around go untouched but a candy bar in the fridge is fair game. Lunch was quinoa and black beans dinner rice with beans and sausage. We sat around and joked and talked then headed to bed.

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