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 1 in Haiti

Day 1 Mamababy Haiti

A 3rd time mom N., and  her husband have arrived with mom in active labor at 7 cm. In my practice in the states women very rarely have internal cervical exams. The clinics policy is a check at arrival and then no sooner than 4-6 hours later if not necessary. They had one midwife who came who was very upset about the frequency of exams so she did a mini class for the staff midwives about other ways to assess dilation. Her main emphasis was the purple line. As the woman dilates and the baby moves down deeper in the pelvis and pushes on the sacrum the tissues spread from the buttox crease revealing a purple line.

Photos credit of scienceandsensibility.org

The clinic tried it with the next mom who came into the clinic. The woman ended up delivering alone in the bath room 10 minutes after arrival when the purple line said she was 3 cm.  Needless to say they check everyone now at least once.

She is a very calm birther and smiles when I talk to her in English. I am to only watch and chart for this birth. Her labor progresses slowly and she doesn't end up having her baby until much later. Another woman J, comes in with short spaced contractions. We check blood pressure FIRST THING. This is really different than in the states where I usually listen to baby first before assessing mom. They check blood pressure first thing as high blood pressure and pre-eclampsia is a real problem in Haiti and they send them to the hospital right away if there is a problem before mom starts seizing. Blood pressure is fine. A cervical exam is done by the student and I follow her to double check. She is only 2-3 cm. We tell her she can stay and encourage her to walk to speed up her labor. When I ask her when she ate last she says yesterday at noon. I bring she and her friend a mango and cassava bread with peanut butter. They hang out in my favorite decorated room.

Prenatals start at 9 but the women start arriving as early as 6 but most come at 8. Dressed in their best they sit on the covered porch and talk with each other. They are lovely people. I am so excited to be working with them. They laugh quickly and are so kind to each other as they tease and poke about the different aspects of pregnancy. There are 28 today. A small devotional with a scripture, prayer and song is done at 9 and then prenatals start. The interpreters gather their names and pull their charts as well as do weight and blood pressure. The two native midwives are away for some midwifery training so it is just Mary, Martha (the advanced student), myself and a native student Genni. We do two prenatals at a time with an interpreter by ourside. I watch Mary do one but she gets distracted with Martha and I work through the rest with Genni. It is very different doing prenatals when you do not know the language and culture. Thank heavens pregnancy is universal and most mother love talking about their cute growing bellies. I ask questions and they are repeated by the interpreter.  That takes some getting used to, but the interpreters are kind and very experienced. It makes me smile that they are all male. I asked a mother once if she minded having a male interpreter and she said no most of the doctors are male so she sees the interpreters in the same way.  Most of the moms are happy and healthy. They are all severely anemic. We talk and measure bellies and listen to babies. Every mom is sent home with 10 days of prenatals and iron supplements with a prescription to purchase 30 days worth. Most don't have the money to buy them so they wait until their next appointment a month later to get more. Common complaints were acid reflux and lack up appetite. I only saw one with morning sickness. More common in Haiti is "spitting" during the first trimester. An abundance of saliva causes the women the spit frequently and some of them carry around a cup. A first time mama lay down so I could do fundal height. It was the first time she came to the clinic, she was 29 weeks. When I went to touch her belly, they have the softest skin ever by the way, I palpated belly only to feel fetal head and a tiny ear right under the skin. I pulled back surprised. Sure enough you could palpate every fetal part. It was concerning. Measurement was right on and FHT strong but I called in Merry and we agreed a sonogram (costs $25) would be best. Baby implanted out of uterus? Bicornate uterus? Additional note: baby was indeed implanted out of the uterus. They did a c-section at the hospital and baby did not survive but mother did. After I wrote the prescription for the ultrasound Mary called "Baby is coming!". The mother handled her labor like an expert.  Mary broke her very, very bulging bag of water to avoid a shower and baby boy came easily over intact perineum born on a birth stool. Baby born at 11:49 and while drying baby on mom we heard a plop at 11:50. Placenta had come out in bowl. I had never seen a placenta come out so quickly. One shot of pit was given but there was no bleeding as per their protocolls. The odd thing for me was mother had no desire to touch her baby. Very different than in the states. I have seem women who have had a very undisturbed birth often wait a moment or two to touch their baby. Almost like they are waiting to come out of labor land back into reality. More often is is an ecstatic smile or sound. I wonder how much of that is cultural? We are told over and over and shown in videos that you are supposed to be very happy and reach for your baby. I wonder if that would be the case in the States if there was not that expectation. The baby was very healthy and so beautiful. The family is just beautiful together and very happy. I don't get to observe the post partum procedure because there is other work to do.

 I went back to continue prenatals and did a couple post partum exams. A mom with a 5 mo with a cough. A mom who birthed at the clinic 3 days earlier with foul stitches. In the states many women due to good nutrition do not tear. If they have a slight tear we often encourage natural healing methods such as seaweed and staying in bed for a week. Staying in bed for a week is not an option in Haiti. Women tear more frequently due to poor nutrition so they do more suturing. The Haitian people are very very clean often doing bucket baths several times per day, but even with that being around all of the dust and rural living infection is common. The woman was sent home with antibiotics. Things calmed down.

We ate lunch of corn mush with black beans and a sauce made of okra and crab and beef. It was very good. Breakfast had been pancakes and dinner was spaghetti, only spicy with hot dogs in it. They tend to make everything spicy here.

 Around 6 Claudin, an interpreter who has been giving us Creole lessons in the evenings, asked Martha and I if we wanted to go on a walk around the block. We agreed and it was fun to be out in the community. The women smiled and a few men cat called but everyone was very nice. After our walk we talked about culture, marriage, and homosexuality. There are many different religious views in our little group including.. Mennonite,Mormon, Baptist (preacher in training), ex- Methodist preachers daughter, and vudoo. It was a nice evening but the mosquitoes were out in full swarm so Martha and I hid under a big white mosquito net while sitting on the deck looking ironically like two lesbian brides. We laugh a lot and Claudin likes to poke fun at our names comparing them to Creole words. Mine is similar to diarrhea, Mary means husband and Martha is similar to liar.

I went to bed when the power was turned off only to be called back by the 2nd mom from earlier who had gone home around dinner when her labor stopped. She was back but after exam was found to be no different. 2cm. She was exhausted. I gave her Benadryl and sent her to bed at the clinic. I took a bucket shower; like it sounds you sit in the shower and poor cup fulls of water from a bucket over you. It was actually very refreshing. They have running water from a well when the power is on. The city doesn't have enough power for everywhere in the city to have it at the same time so they cycle through and randomly turn off the power. You could go weeks with out there being city power. City power is also shockingly expensive even with how rarely it is on it is not uncommon to cost close to $500 a month.  The clinic uses a generator to pump water from the well into the storage containers on the roof to be used for showers and toilets. They also turn on the generator at night once a laboring mother is close to pushing.  A bucket shower is quite nice. Then I crashed and slept hard.

Community School of Midwifery

Midwifery School

I went through quite the ordeal in order for me to sit for the national NARM exam and finally receive my Certified Professional Midwife credential. I did self study and had much hands on support from my preceptors but little help with book learning. I vowed to do everything I could to make it easier for all my midwifery sisters who came after me. I was asked to join this amazing midwifery school and assist them as the Academic Dean. I am both humbled and excited by the opportunity. The school provided weekly in person education for midwifery students at several Utah locations. 

Please visit http://www.thecommunitymidwife.com/ for more details.

What? Your Midwife is Human?

Criticism. 

As birth professionals this is definitely something that you will come in contact with. There are so many factors going into a birth. Many you can control and many you can’t. Talk about a hormonally charged profession. Groups of women who are often on the fringe of legality and acceptance working with hormonal, uncomfortable and often sleep deprived women, truly it is a recipe for disaster. So it should be no surprise to us when someone is not completely 100% satisfied with their experience. But man it hurts to hear it. As midwives we give so much of our selves to our clients.   To hear that is may not have been enough cuts deep. However criticism can be to our benefit if we handle it appropriately. I have birthed with four different midwives, worked with dozens of other doctors and midwives and have helped numerous couples with their births placing me often on the giving and receiving end of criticism. I have been on both ends of this and here is what I have learned and what I aim for.

Here are some ideas on how to receive and react to criticism.

1. When someone approaches you wanting to give feedback  make sure you have adequate time to fully discuss the issue. The last thing you need added to the criticism is feeling like it is rushed and not complete. Nobody likes unfinished business.
2.  If you are extra sensitive and emotional ask to receive the feedback in a medium that both you and the client are comfortable with. I am a verbal person so I would much rather have a conversation in person or on the phone while others might prefer email or a feedback form. If you know you can’t contain your emotions while receiving feedback in one way choose one that you can.
3. Stop your first reaction. Take a deep breath and think of the situation from all points of view. Remember especially when dealing with birth it often doesn’t matter what happened what mattered is how they feel about it. 
4.  Listen to the entire feedback with out interrupting. Pay attention to your eye contact and physical cues making sure they are appropriate and show your sincere desire to hear them out. 
5.  Reflect and say back to them as close as word for word as you can what they told you. This will give you a chance to avoid misunderstanding and gives the critic a chance to hear exactly how they worded things. It then gives them a chance to clarify if that wasn’t exactly what they meant.
6. Ask specific questions to clarify. Was it something you did specifically? Was a feeling the person had? Was it something not related to you that is being clumped with you because you were there?
7.  While validating their concerns and feelings refer back to the original goals that were laid out together before hand.
8.  Ask if they have any questions they want answered about the experience or did they just want their feelings known?
9.  Answer their questions in a non-defensive manor paying close attention in validating anything they might be feeling.
10.  Thank them for their honesty.(And mean it!)
11.  Ask if there is anything you can do.

Things to remember about receiving feedback as a birth professional

1. Constructive feedback is how we learn and grow
2.  You can not please everyone all of the time.
3.  The birth is about them and not about you. 
4. You are likely to hear one negative feedback for every ten positive experiences that clients have. The negative are much more likely to be shared.
5.  Never put a time limit on them processing their birth or experience. Just because their “baby” is ten doesn’t mean that the experience is not still impacting them.
6.  Don’t talk about the client giving you negative feedback to other clients or midwives. Making them look the fool doesn’t help you any. 
7.  Remember that like and dislike are not the same as good and bad. Someone may not like something you did but that does not necessarily mean they think you are bad.
8.  In the end be the better person. Birth is so amazing, emotional, memorable and life changing a receptive care provider can make a world of difference. Each woman only gets a few births to learn and grow but us as midwives have many.