Day 2:Haiti

Day 2
I woke up earlier than I would have liked but I heard voices and felt guilty being in bed. It was around 6 am. I must have had a few mosquitoes in my net last night as I woke with a dozen new bites. These ones are mean and the itch was driving me mad. I walked out on the deck to Mary doing her daily devotional. We talked a bit and got ready for the day. I went down to discharge the mom who came in false labor again last night. She headed home. I was not feeling well at all.Some sort of cold probably caught on the plane. Breakfast was scrambled eggs and the most delicious pineapple I have ever tasted. 

Friday is the day MBH teaches Family Planning and Mama Baby classes. We also saw a few kids for a national program called Medika Mamba. Mary went to teach the baby class with an interpreter, and Martha who is a nurse, helped do informed consent and screening for women wanting the Depo-Provera injections for birth control. Two new women came, and six returned who had come before. Of those 6, 2 were risked out due to high BP. It is amazing to me how often high blood pressure is a problem here. It leads me to ponder everything I have studied. Is it nutriton, genetics, stress or a combination?

It got really busy quickly. I helped with the Medika Mamba program. Medika Mamba means "peanut butter medicine" in Haitian Creole. Each child is weighed and measured and then compared to a chart that rates their malnutrition, severe, moderate, or mild. There were 6 children today. Two of them were in the healthy range and sent home. The others were given a certain number of Mamba packets and instructed to mix the peanut, oil, sugar and vitamin formula in clean water and administer several times a day before meals. They are expected to gain a certain amount per week. To learn more about the Medika Mamba program visit http://mfkhaiti.org/index.php/the_solution1/treatment/

 

Photo Meds and Foods for Kids

They are also administered amoxicillin and a deworming pill the first visit to eliminate bacterial or parasite issues. I got to snuggle a 10 month old little girl for almost 20 minutes while her mama went to go get some food. She was a doll and after she would fuss and I would get her calmed down she would do that little shutter babies do when they relax. Melted my heart. A very young mom, my guess would be 15 brought in 12 month old twins a boy and girl. 

Severely malnurished little tiffi twin

Moderately malnurished gason twin

The girl was severely malnutritioned and the boy moderate. They were both so cute but their little skinny legs didn't look like they had enough muscle to ever support them.The little girl vomited up the dewormer and I had to go get a syringe and figure out a different way to help her take it.  She was a good attentive mother and still breastfeeding them both. There was a Mama Baby Class taught by Mary after clinic that day with about fiveteen mothers and infants. The other mothers were so impressed when this young mom easily and with little fuss breastfed her two 12 month old twins while listening intently.

After Medico Mamba was done I helped with 2 postpartum visits. A 1 month old had gained a whole kg since birth and mom was so proud. A second mom was having high blood pressure at 1 week post partum and had me check her sutures. She was healing well but we asked her to return next week after cutting MSG from her diet to recheck her blood pressure. 

 I was doing an exam of a 6 month old baby with a cough when they announced a laboring mom came in, Madeline. I admitted her quickly. She had only had one visit and had never returned with hey HIV or syphilis testing so we did a rapid HIV test. We had trouble getting enough blood and the first one was inconclusive, but maybe positive so we did a second that came up negative. I checked her to be 1 cm so I told her and her friends to go walk around the yard. This was her second child. I have been surprised how most of the Haitians I have met only have 2 or maybe 3 children and they are spaced often 4 or more years apart. The average Haitian breast feeds for 18 months. 

I helped with the rest of the sick child visits, gave some opthamalic eye ointment, amoxicillin, and vitamin C. Then ate lunch, rice and beans, and stripped all the beds and changed them. Mary noticed I was still not feeling well despite all of my water and Emergence c packets so she told me to go lay down. I took a nap out the outside deck after covering myself with bug spray. The power has been off since yesterday and that means no fans. It is really hot with no airflow. Medeline was more active after my nap. After she vomited I checked her again, 2 cm. Her friends all left, she had bad back labor and a terrible headache but didn't want me to help. She was much poorer than the other women who have been in. As I wrote earlier most of the women who come in are very clean and although poor their clothes are well kept. Medeline was different. She was very dusty and just looked plain exhausted like she had had a harder than average life, even for a Haitian. She labored mostly naked out in the yard after the sound and smell from the generator pushed her out of the labor room. A few of her very young teen age cousins came for a visit. They laughed a lot and Medeline basically ignored them. They poked fun at her labor noises and nakedness. She had had some mild bloody show that was concerning to her but she labored along.

 I continued to feel worse and worse physically. Dinner was some sort of spicy green soup with fish and crab. Just the smell made me feel nauseous. We all climbed up on top of the roof and spent some time looking at the cities and countryside around us. The houses are all made out of concrete and many of them are huge but almost all of them are unfinished.

Next door neighbors house

 I asked Claudin about it and he said that is the legacy parents leave their children, a huge unfinished house. At around 8 pm a friend of the mamas came and gave her a hard time for just laying in the bed. I checked her again, no change. We told her that she needed to either drink and eat or we would have to start an IV. She drank a little water and Emegcen-c and we put her to bed with Martha checking on her every few hours through the night. The power was still out and the center was hotter than it had been since I had been there with the power out for 36 hours. I made a cup of chicken noodle soup and instant oatmeal, took a bucket shower and headed to bed. It was so miserable. I moved from bed to bed trying to find a cross breeze. Nothing worked. I was probably the most physically miserable I had ever been without pain. I felt like my skin was burning up from the insect repellant I covered myself with. Finally some time after midnight I felt the fan start up and the power was on. With Martha downstairs I moved the fan right next to my head and between the cool  breeze and white noise, I couldn't wear my ear plugs due to my cold, I finally fell asleep