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.

Dixie State College Radio Show 1Voice-Maternal Health Disparity a Utah problem, a US problem a worldwide problem

I had the privilege of doing an interview with Wendy Worthington, the director of a local radio show at Dixie State College called 1Voice on the issue of maternal health disparity. Maternal health disparity addresses the issue that regardless of the fact that we are one of the most industrialized nations in the world we still loose far to many mothers and babies, especially of non white back ground, during pregnancy and birth. Why? I address that question and many more including education of midwives and Mamababy Haiti in this podcast.

1Voice Podcast on Maternal Health Disparity

Day 4:Haiti

Day 4- Sunday

I was up most of the night with Kesseley and her baby girl but I decided to eat my pumpkin soup which was delicious.

 The history of pumpkin soup begins with the celebration of Haitian Independence in 1804. On Jan. 1, 1804, Haitians worked together to create a unique soup to celebrate their independence from the French Colonists. Until that time, the Colonists believed that the blacks under their rule could never work together to create anything. Today, the traditional pumpkin soup known as "soup joumou," is made and served to friends and family in Haiti in remembrance of their fight for freedom. While under French Colonial rule, Haitians were limited to eating a bland bread soup. They would not have been permitted to eat such an extravagant meal comprised of pumpkin, beef stock and other vegetables. This unique soup was created as a symbol of unity in the face of adversity. It was served to everyone at the first Independence celebration and Haitians continue this tradition today.  

 Haiti was the first independent nation in Latin America, the first post-colonial independent black-led nation in the world, and the only nation whose independence was gained as part of a successful slave rebellion.

I decided to go to the local Baptist church with Santo and Mary even though I was exhausted. There were about 60 people in a cement building. It had no door or glass windows just an opening for each. They were all dressed in their Sunday best. The children were very well behaved. Shockingly well behaved compared to American children. They were happy to sit on their mothers laps. Something I noticed that was different was how parents held sleeping babies. In the US babies are often held in the cradle position while they sleep or occasionally over a shoulder. In Haiti as they lay the child over their knees similarly to how you would position them for a spanking and they would happily fall asleep there. I saw one mother at the church scowl at a 6 or 7 year old boy several times as he was getting restless before she laid him over her knees and he fell asleep with his mother patting his back. It made a lot of since as Haiti is hot an humid and that position was far less body contact and much cooler as they could fan the child while they slept. 

Photo courtesy of latimes.com
There was about an hour of worship singing and prayer followed by the preacher asking Mary and  I to come up and say or sing something. We sang How Great Thou Art.  It is such a beautiful universal hymn. It brought tears to my eyes as we sang it. The smiles from all of the lovely people was well worth the embarrassment.

 

A guest speaker, and American missionary fluent in Creole, spoke for the next 2.5 hours. About 2 hours in I was just done with sitting on the cement bench. The way the speaker spoke was different than I am used to being preached at and while I was attentive for quite a bit of time it started to get to me after a while. That combined with smoke coming in from the nearby door drove me to go sit outside. There is not real sanitation set up in Haiti so in order to deal with the trash many people have trash burn piles regularly. It smells awful and makes the air very smoky but it is preferable to the alternative. 

There I watched a 4 year old boy fill up his water containers for his family. Each plastic container, similar to a very large vegetable oil container, held about 2 gallons of water and I couldn't help but think how my children complain when I ask them to carry one gallon of milk in from the car. He pumped and filled the containers but the pressure coming out of the faucet was so great it left a good 25% of the container empty. He remedied this solution by  proceededing to fill up the tiny caps with water and poor it into the container. 50 fill ups later the containers were perfectly filled and he lugged the water back home. His eyes never left mine. Clean water is probably the number one problem in Haiti. The water from the pumps still needs to be boiled to be safe.

The water at the clinic is all braught in large 5 gallon jugs and dispersed from a cooler. Water for toilets and washing comes from a well on the property. Electric pumps pump it to the roof and store it in large containers to be used later.

                         This is similar to the ones at the clinic.

Most people get almost all of their drinking water from little plastic bags filled with water. The huge disposable water bottles used in the US seem very wasteful in comparison.

Service let out and we headed home. Lunch was chicken, so delicious, rice, potatoes and salad. I then spent the next 3 hours napping in my favorite place on the love seat. It has a cross breeze so even when the power is off, which it was again, I can be cool enough to sleep. Claudin came and we did our Creole lessons with Martha and Mary. A little known secret about me is that I really struggle with foreign languages. I almost didn't graduate from college because I started and dropped Spanish 4 times. Ultimately I took American Sign Language from another school and had the credits transferred in. Between the foreign language, my cold and missing my family so much I was just in tears. Wondering if I made a huge mistake in coming here. When we are busy I felt better but these two days off with no clinic and no births were really difficult.  Dinner was a packet of tuna and a Luna bar since the cooks have Sunday nights off.  I started the night inside but there were three mosquitoes in my net that I couldn't catch and I knew I would be miserable in the morning. I took a Benadryl and slept wonderfully in my bed under the stars. 

I finally perfected my bed under the stars. I got a lot of flack about sleeping out side. Another volunteer claimed she was going to "Suck it up inside with the heat and the bugs because she would acclimate quicker and be a true Haitian." I thought she was crazy and sure enough I was the intelligent one. 

I would get ready for bed every night which was quite the order

 *drag out the matress

* use clothes pins to hand the mosquito net

*tuck net under the matress
*twist openings and use close pins to keep out mosquitoes and check for holes

* gather my supplies which included my Nook, Jounal,eye mask, ear plugs, water bottle, flash light and hand fan (yes I was a little high maintanence)

*spray myself with repellant

* fan myself incestinatly as the DEET ate away my skin and gave me the worst hot flashes ever

*cry a little bit and miss my family

* say a prayer and beg for strentgth

*stare at the stars until I slept or if it was raining pull my fleece blanket I brought with me over my head and ignore the wetness.

I slept out side from then on. It became quite the routine and as I settled in I watched all of my Haitian neighbors settle in with similar routines on their roofs. They would wave or say hello. So who was the crazy one? Who would acclimate quicker? I am an avid camper and often sleep outside but this was the longest consecutive length of time I slept under the stars. I felt very claustrophobic when I got home.

Day 3: Haiti

Day 3

This day was Saturday, a free day at the clinic. No prenatals or classes scheduled. I slept in a little but not too much as I knew I needed to go check in on Medaline and probably discharge her. Not being woken by Martha let me to believe that her contractions stopped and she had slept. I was right and after she had some breakfast, oatmeal, I sent her home with a prescription for a syphilis, and HIV test plus and ultrasound order with instructions to do them all on Monday and return for a prenatal on Tuesday unless the bleeding worsened or she was in labor again. She happily agreed. I ate breakfast and some Benadryl and Tylenol for the cold and promptly fell asleep on the couch in the family room where I slept for 90 minutes or so. I woke disappointed that the power was out again, but Mary invited me to go on a walk 1/2 a block away to the cemetery which had manicured lawns and huge shade trees. I agreed and here I am now.

I think I am going to take this time to describe MBH the best I can. It is a large concrete building painted a pale yellow and white. The yard is compound like everything else in the neighborhood, probably .5 of an acre. There are three doors on the front of the house. The one on the left leads into the kitchen which has a refrigerator, oven, back up propane powered cooking station and falling apart cupboards full of dishes and pots and pans all covered with clean cloths or mesh screen to attempt to keep out insects. A wall of 5 gallon water bottles for the water cooler lines one side. If you continue through the kitchen you enter the court yard where they have the outside kitchen to cook, do laundry and wash dishes. Dishes are washed in three large tubs. One for soaking and cleaning, one for rinsing, and one for disinfecting with bleach water. Through the second door on the front of the house you enter the teaching and post partum room. Four single beds line the walls. There is a baby care and weight station and pictures of teddy bears and nursing mothers on the walls. The room is separated by another little entry room by a navy blue drawstring curtain. Yesterday this room was full with Mama Baby class participants, Mamba baby families, and postpartum families, about 20 in all. Through the blue curtain is an entry room from the postpartum room, kitchen and reception area. It has one bed there for triage and treatment plus a child sling scale where the child sits in a special cloth that is suspended from the ceiling on a scale. There is a small cabinet with pregnancy tests, HIV tests, glucose tests, thermometers etc. When you enter through the third door on the front of the house you enter a screened porch. This is where the mothers sit to wait to be called in for appointments. You don't make exact appointments. You tell them to come in 4 weeks and they come back around then. The first to arrive gets the seat closest to the door and is the first called. So they begin to arrive around 8 am and by 9 am when it is devotional time we have 10-30 women there. That room leads into the small reception area with a desk and an armoire that holds medications and vitamins. To the immediate right is the garage which has been converted into a large store room for supplies. On the far end of a reception area there is another bed that is used for triage or as an extra prenatal space. To the left is the hallway to the kitchen and postpartum rooms as well as the stairs to the upstairs. Just past the storage under the stairs is a labor room with the MBH logo painted on the wall. Two beds and a bathroom plus a supply shelving area.  From reception to the right there is a single labor room decorated with birds. A bathroom. A double laboring room decorated with painted flowers. There is also a hall way that leads out the back of the house to the grounds keepers’ home. Up the stairs opens into a great room with a small desk and office supplies. There is a large family sized black table with benches and two love seats and a coffee table. Shelves along the walls hold books and food supplies and condiments that belong to the midwives and other house staff. There is a door that leads to a covered deck. I spend a lot of time out here and often nap there. Off the great room is another large room called the over flow room. It holds overflow baby supplies and medications that will get too hot in the garage plus 3 more bunk beds for over flow staff. I often sleep on the top bunk as a breeze from the deck on the end makes me feel less clausterphobic.  Off the great room are the midwives quarters with a bathroom and 4 sets of bunk beds. Mine is a bottom bunk in the far corner away from both windows. Thus the closterphobia.  Another midwife room off the great room leads to Mary’s room where the directors stay, there are two beds. There is a bathroom and a third bedroom which has four bunk beds where the site manager, Santo, who I have not met yet because he is out of town, sleeps. The yard has a huge empty swimming pool, a chicken coup, two green houses and plants everywhere including beans, peas, tomatoes, corn, egg plant, lettuce, greens and other plant foods. Trees of mango, papaya, banana and sugar cane are also around. The whole house is very clean. The cleaning woman wipes the walls and mops every floor with a bleach solution every day. Building materials are difficult to come by so paint is chipping, windows need caulking etc. but they keep things very clean and tidy and I feel very safe even with all of the insects around. I am hoping for a few labors to come in today.

Chicken Coop and Banana Trees

Green Houses and Mango Trees

Women Waiting for their Prenatal

Birth Room with MBH Logo

Sun Room Birth and Prenatal Room

Birth Room Birth and Prenatal Room

Flower Room Birth and Prenatal Room

 Laundry is almost always drying around the Clinic yard

Sugarcane

Papaya Tree

Staff Family and Dinning Room

Clinic

Swimming Pool- This made me laugh because there is almost a page in the volunteer handbook about how you need to dress modestly when you are using the swimming pool :)

Passion Fruit Vine

When we got back I spent several hours napping as did the other midwives. We then decided to go for a walk up to the rock quarry about half a mile away. We stopped by the MBH children’s library and met the family featured in the you tube video. We saw many different people, animals, and houses. When we got to the quarry rain water had collected to form little pods where people were bathing and animals were watering. We climbed a steep hill and we were able to see all around us up the mountains to the east and the ocean to the north. It was very beautiful.

When we got back a labor was there a first time mom named, Tetalley. She was very sweet. We had spaghetti for dinner and mom and her sister Nahnah walked around. We told them to come and get us when things got more intense. I crawled into a new bed under a mosquito net out on the porch and waited. Around 10 Martha came and got me and told me she was active. I went down and found her rolling in bed with the pain. We got her centered and I did an internal exam and found her to be 100% and 5 cm. Her mother had shown up by that point and kept pulling up her skirt and opening her legs wanting her to push out the baby. I finally got her to leave her alone and she labored with us holding her hands, rubbing her back, and putting water on her belly. Around midnight she said she had to poop and I checked her and found her ready to push. Martha went and got Mary and they were going to turn on the generator when a miracle happened and the power went on. She had a very tight hymeneal ring. I was worried about her tearing on the birth stool so she pushed a few contractions there and then we moved to the bed. She would not have torn except for a nuchal hand that popped out. Baby had great apgars and cried eagerly.They worked beautiful together and grandma was so happy.

 I ended up needing to suturing her up a bit. She showered and then we moved her to the postpartum room where we worked on breastfeeding. I crawled into bed at 2:30 but still didn't sleep well as the baby was up often during the night and I went down to help the mama. She was exhausted and a little shell shocked which is pretty normal for a first time mom no matter where you live.

Photos of individuals shared with permission that was obtained prior to taking photo.

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