So-called Inconveniences

I went to a matròn graduation in Thomassique last weekend.

The medical team from Richmond, VA left today along with the MFH directors and a midwife from Roanoke. Needless to say, it was a big group! I have sent off group after group but never felt that I was ready to join the “return-to-the-States-crew”. It wasn’t until today when I had a twinge of regret that I was not boarding the Pink Jeep to Port-au-Prince. I missed my brother’s graduation from Virginia Tech yesterday (congrats Elliott), and so I think it was the realization that I was missing a fun family function that made me want to return home.

MFH partners with Medical Missionaries at St. Joseph.

There is nothing about Haiti that makes me want to leave, however. Despite the constant household needs, the long waits, the general lack of preparation, and high-carb diet, I am content living in Haiti. What are all of these “inconveniences” anyhow? Am I truly inconvenienced when the water cistern goes empty for the millionth time or when the medication invoice charged me for one item too many? Though irritating, I am often reminded by the harsher realities of life here that make me think less of the small things. For instance, though I am tempted to become aggravated by the so-called inconveniences, I think about real life cases, such as that of a current patient at the hospital.

It was two-weeks ago when one of the volunteers came back from the hospital talking about a 19-year old woman who had lost her baby. It took a couple of days to get the patient’s entire history, but when we did we were astonished at what we learned.

I helped get the teacher, materials, and other
matròn training advice to the coordinators
at St. Joseph.

The young woman came in at term. Accompanied by her sister, she had a normal delivery and a healthy baby. All seemed well until the midwife realized that the baby wasn’t nursing. The new mother hadn’t fed the newborn for at least two days. She refused to breastfeed. What was worse, the midwife couldn’t find any affordable milk powder for the child. A couple days later, the baby died of starvation.

Danielle & John - I had traveled to northern Haiti earlier this year.

A baby dying of starvation in OUR maternity ward is unheard of nowadays. Without going into what should have been done regarding the care of the newborn, I want to return to the young woman. She was soon found to be incontinent of both urine and feces, unwilling to speak, and obviously depressed. Her sister had been her spokesperson all along. She had come to the hospital this way because, as retold by her sister, had gone mute at about 15 years of age when the family realized that she had been repeatedly raped by village men.

I had known about the case since the volunteer came back with daily reports on the patient. It wasn’t until a few days ago when I realized that there was still very little progress made on her behalf. What social services exist in the area had been contacted but had made no full assessment. We are still waiting on the psychologist’s evaluation of the young woman.

Of course, lots of songs and presentations!

I don’t know why it took me two weeks to finally ask my contacts for help. Maybe it was the realization that the woman had no where safe to go that bothered me or the idea that my peers were handling the situation well enough that kept me on the sidelines. Whatever reason, I had first seen

The proud group with their certificates and badges.

this case as an inconvenience rather than a life that needed full attention. The jeep breaks down. The roof starts leaking. Compared to matters much more severe, the so-called inconveniences that I experience on a daily basis are not worth a breathe.

The Cultural Reality

Dr. Steven Eads demonstrating how to handle
a shoulder dystocia. 

I’ve been having a lot of discussions this week about the Haitian midwives and their efforts they put forth at the hospital. Though I am aware of my surroundings and understand how Haiti offers different cultural traditions, I am still confounded by some of the behaviors and events that take place here. I’ve given two observations in this blog. Though they come off as negative, I am neither critiquing nor judging the Haitian culture. No matter what the case, I am just passing by, only here for a brief space in time to experience, not to change, the behaviors of a people very different from my own.

Some of the midwives practicing neonatal resuscitation.

When a baby comes out unable to breathe, the midwife must perform neonatal resuscitation (NR). There often is no oxygen and the NR method is the quickest procedure to keep the baby alive. In the labor and delivery room, the American volunteers have frequently put together a kit that contains all of the emergency items needed for these cases. The Haitian midwives, however, do not maintain the kits. In fact, they hardly maintain the supplies at all. When something runs out, no one realizes it until the item is needed. Why are the Haitian midwives negligent in managing lifesaving materials? One reason could be that no one midwife in particular is assigned to overseeing supplies. The task falls on the group as a whole. Because we have poor supervision in the unit (not by MFH’s doing might I add), the midwives settle for having to find items on the fly, even when lives are at stake.

The matròns waiting for their monthly continued
education class.

A woman gave birth to a baby with a large encephalocele (when the brain forms outside of the body due to a neural tube defect). The hospital in Hinche is not equipped to care for a baby born with this deformity. Everyone knew that the baby wasn’t going to make it. Because there are no private rooms in the hospital (there are at least 10 beds in the ante and post partum rooms with no curtains) the woman and her baby were out in the open with no privacy. The students and most of the midwives, never having seen a baby looking like this before, were laughing. They were giggling amongst themselves, confused and probably scared by what had taken place. From my perspective, I found it odd to be laughing in a situation like that. But, taking a step back, one has to ask, What cultural tendencies exist that formulate one’s expressions towards fear?

Class 6 (both sections) in front of the Guesthouse.

Now, it could be that the midwives fear death and the unknown and just don’t know what to do in the face of it; hence, the awkward laughter. I have no doubt that our midwives have sympathy and compassion for the patients they care for, but it is rather troubling when you see and hear laughter when a mother has given birth to a baby, though ghastly looking, won’t make it past three days. Maybe they feel the same thing as a Westerner, just that they don’t cry silently or leave the room. I didn’t ask the students how they felt when they first saw the baby, but I assumed that they felt no different.

Getting ready for class. 

My time is too brief here to find answers to these cultural conundrums. Because I did not come to change how the Haitian people do things, I can, at some level, accept the differences and respect the people for how they express themselves no matter the situation.  

A View From Above

I just got in this morning from Jacmel, a small city with a French colonial twist on the southern coast of Haiti. As you can tell by the pictures, I came by a 4-seater plane. So much fun! It only took 30 minutes to cover the 4 hr road trip that we would have had to take. 

Taking flight.

A view from above.

Can you see the tiny runway? About to land in Jacmel.

After spending a few days with Every Mother Counts' Founder, Christy Turlington Burns (http://www.everymothercounts.org/author/christy-turlington-burns), and her staff, Nadene, Steve, and I were off to Port-au-Prince for a ceremony at the Partners In Health Hospital (http://www.pih.org/media/the-road-to-mirebalais). There, we had a grand tour of the finished hospital led by PIH staff, including my long-time hero Dr. Paul Farmer. I was really close to actually shaking hands with him, but I did get to hear him speak. Ben Stiller, Senator Bill Frist, GE, the Dean of Harvard Medical School, et al. were among those in the audience as well.

Our artsy Hotel, La Florita. 

Having to go to Port-au-Prince to catch a flight the following morning, we left early afternoon for a meeting with a consultant before retiring at a hotel nearby the airport. Nadene told me that it was constructed with giant containers. Apparently, it's the first paraseismic steel construction in Haiti. I could care less about the structure, I was just happy to get of Hinche for a bit. It had been 2.5 months since my last away trip. 

Leading into my corner room at La Florita.

In town. Notice the French double doors?

Arriving in Jacmel, we found our sweet hotel La Florita to be full of character. Though a little rundown, it was nice to be able to access the internet and order a cheeseburger all in the same place! We were situated right in the middle of town, so our location made it easy for us to jump around from shop to shop. Oh! Our trip's mission! Our trip itinerary consisted of purchasing art for an art show this summer at the Cultural Arts Center at Glen Allen. I will send out an official announcement later, but it's a great publicity and fundraising event for MFH, and so we would love your support. Not too mention there will be art from all over the world shown there. If you are interested in a piece now, let me know!

One of the all murals in town. 

So, we got around quite a bit picking out art, meeting some of the artists, and finding restaurants. Yes, meeting some of the artists. We actually visited them at their homes. They didn't seem to care. They were just happy to have business! We ended up purchasing 36 works all together. 

The beach needs some work, but the view is great.

Nadene trying to decide what will sell. We will see!

Wilbert Laurent at his house.

 As I am finishing up these last seven weeks (which are going to fly by), I am going to try to include some of my reflections on my experience. To start off, one of our Board members Dr. Alice Hirata offered that this year managing the program on-the-ground is a great base to have as I continue on with studies and career plans. I completely agree with her. Working with a huge variety of people as well as building professional relationships with the Haitian staff may come in handy in another aspect of my work-life down the road. More to come later!

The place has so much potential to become any tourist's dream vacation.
The lack of safety net, political stability, etc., however, keeps the area in poverty.

It's a Celebration! From mothers to babies to new chapters.

A new mom and her baby from this week.

I had a lovely time meeting two doctors from England and Ireland this past week. Both were taking a year off before committing to a field and were interested to learn about MFH and our Matròn Outreach Program. They were trying to implement their own program for their local group of matròns in a different part of the country. It was especially nice to have these two ladies meet two other doctors, one American and the other Irish at dinner. You never know who you are going to meet!

Miriette, one of our students and my housemate, doing
a neonatal exam.

I also had an interesting experience with immigration this week. A Haitian-looking woman walked into our compound the other day. She found our manager, but I was soon called to the scene. I was surprised to find that this woman (who was 7 months pregnant) did not speak a word of Haitian Creole. Only Spanish! Thank goodness we had one of our translators who, along with being fluent in English, speaks fluent Spanish. This woman said that she was deported to Haiti because she didn't have a green card even though she had grown up in the Dominican Republic. We gave her some money and helped her on way. I am not sure if she ever made it across the border, but I can only hope that she made it home.

Mirline, one of our preceptors and my housemate, working
with our students.

Aside from the house calls and the daily volunteer and staff needs, I have been doing what I can to help with our Spring Fundraiser, "Thank Your Mother and Save Another". Don't know what to get your mother for Mother's Day? May 12th is coming up fast! Check out http://www.midwivesforhaiti.org/.

Oh, and PLEASE watch this video if you have five minutes. Every Mother Counts was founded by Christy Turlington, a successful model, who wanted to reach out to women and promote maternal health care after a scary birth with one of her own children. The organization just produced this beautiful video (I met the film-crew when they were here filming) found at http://www.youtube.com/watch?v=Sdzg7bIpK-o.

Our students are getting in their first births in the hospital.

I hope you enjoy it! It is amazing how time has flown by. I will be back in the States in two months. Still much to be done and experience, of course! I have come a long way in many respects since I first arrived last summer in Haiti. I hope to include some reflections in the coming weeks.

Full House

A volunteer teaching on how to recognize a post-partum hemorrhage.

First and foremost, Midwives For Haiti has started its Spring Fundraiser to raise $50,000 by Mother's Day (May 12th). If you haven't come up with a nice gift idea for your mother, check out one at http://www.midwivesforhaiti.org/. Thank your mother and save another!

I sent off 11 volunteers yesterday. We had 13 total (in addition to the six residents in the house), and so there were literally bodies everywhere. Not to mention the constant flow of questions and inquiries like "where can I find _____" was coming from every direction.  I certainly have no problem now entertaining people while overseeing my routine duties, but I must say I was a bit more tired than usual by the end of the week!

Philomèn (one of our mobile clinic midwives
giving a class at one of the clinics.)

Before the week started, I helped see two successful trainings through - one was the MFH Continued Education Class that we hold for all of are graduates and the other was on HIV prevention for mothers and babies at the hospital. It's a good sign when other staff members ask when the next one is, so that they can take time off to attend the training. As you may already know, access to education in Haiti is difficult, and so any news of a "training" is welcomed by most Haitians. Especially ones that are free of charge.

One of my unexpected house calls this week was from one of our graduates who was working for an American-funded birth center in Northern Haiti. She had just lost her job. I think her idea of recompense was coming to MFH and complaining about why she thought she was let go. I had already communicated with the director of the organization and was already made aware of the reasons behind the decision. This midwife, however, thought it was appropriate to have her voice heard nonetheless. Though I listened to her throughout, I followed her story with a firm, "MFH is not responsible for the decision and cannot do anything to change it." We help find these midwives jobs once they complete the program, but we are not responsible for what happens after. This is a no-brainer in American society, but in Haitian culture, the idea of "community-help" comes at a different angle.

The usual sunny day at the house (a 20min walk from
the hospital). 

I think my love of chocolate has grown throughout my time here. Granted, it's the simplest thing that I can think of when a volunteer asks me what they can add to their suitcase. Do I ask them to bring a box of Ghirardelli brownies for my cravings or life-saving cytotec (for labor induction) and much-needed gloves?

Waiting to be seen at a mobile clinic.

Either way, my housemates are quick to notice wrappers and bags thrown in the trash. They remind me of a popular saying in Haiti that goes, "When you love something so much, then the doctor/midwife had cut your umbilical cord with that very thing." My Ob/Gyn must have used a blade sterilized with chocolate sauce then!

Unexpected Phone Call

I got a call around 11pm last night from one of the volunteers who was doing a night shift at the hospital. The Ob/Gyn from Alaska said that he needed an internist right away because he had a pregnant woman just arrive. She sounded like she was taking her last breaths. 

Safe twin delivery yesterday (the midwife on the right
is the one who was on the nightshift last night)

The only internist I knew was the American who has been working at the hospital since the fall for Partners In Health. I called a friend who passed along the message. 10min later the internist arrived at the hospital.

The story I got early this morning when the volunteers returned from their shift goes as follows:

At the beginning of our shift, nothing was really going on, so we decided to put in a movie. About a minute later, a man walks into maternity with a limp woman in his arms. She was making some faint sounds, but it was obvious that her breathing was obstructed. She was having an asthma attack.

The man was not her husband and did not know that she was pregnant. He had just walked in looking for someone to help. (We don’t know who he was, but he saved her life by carrying her to the hospital).

The staff midwife who was on the shift with us said, “Why don’t we just put an IV in her and wait for her breathing to get better?” We replied that she would die if something more couldn’t be done to improve her breathing.

Some children hanging out after school (Cheryl Hannah-Truscott photo).

We then went to the ER thinking that the staff there could help us. The 1^st year resident that we found said that they could not take her because she was pregnant. 

We were running out of options. The medical director even stopped by and said that we could use the hospital oxygen, but we knew that this woman needed more help than that! He left after we declined.

That’s when we called Carrie to see if she couldn’t get ahold of the internist (who we had just met in passing during our hospital tour with Carrie) to come examine the patient.

When the internist came, she immediately went to the ER, took the nebulizer, and filled out a prescription for some proper drugs. The woman slept soundly the rest of the night, breathing and alive.

One of our volunteers showing a "skin-to-skin" youtube video.

This chain of events illustrates how a simple process of getting someone out of danger can be hindered by the lack of skills, knowledge, and proper protocols for fast and accessible healthcare. It’s not that the Haitians staffing St. Therese Hospital don’t care about the ill and dying, it’s that they aren’t equipped with the right training to do all that they really could do. Even our midwives who go through an intensive training struggle with making the right decisions on a day-to-day basis. I am a firm believer of the UN's principle, "a human right to healthcare," in its Universal Declaration of Human Rights, but something is missing! I think it should instead include, “a human right to First World healthcare,” or care that you and I and, hopefully, most people in the United States and other developed countries have access to. 

Post-op baby (Cheryl Hannah-Truscott photo).

There's no easy fix

Volunteers ask me how I learned Haitian Creole. I tell them that I minored in French in college. But, after Thursday's meeting with Haitian Department of Health and its partners, I think I am going to leave that part out now.

Making introductions at the training. 

Because it was a state-sponsored meeting, the presentations had to be in French, which is the official language of Haiti but not that of the people I might add. I struggled understanding but was able to read the Power Points. Luckily, my interpreter translated general key points during the meeting for me - the Haitian Ministry of Health will be implementing a ten year National Health Policy strategy that will focus on improving community health. The government will fund the training of health agents who will staff community health clinics around the country. The goal is to improve access to health care in Haiti. MFH was invited because we are a partner of the Ministry of Health. There's going to be another meeting in three months, at which we hope to make a presentation about one of our projects. There may be funding involved!

New location - MFH Guesthouse.

Being silly at dinner (my camera's flash doesn't do the
darkness justice).

I'm including some pictures from this week's Matròn Training for Trainers. I described it already in my last post, so you can return to that to learn more about the purpose of the course. The training was supposed to be held in a building at the hospital but the "reservations" that I had for one of the rooms weren't good. So, we had to move everyone to the MFH Guesthouse in the middle of the course. I was a little frustrated about that, but what can you do? On top of that, the head instructor had not informed me about the stack of papers that had to be prepared and copied for the participants. But, we had a solid group of sixteen, who are now certified to train matròns anywhere in the country. 

What a fine group - participants and instructors together.

I almost forgot to mention - we had no power for two days at the house. A part in our generator (which charges 24 large batteries that supplies the electricity for the house) had to be replaced, and so we sent one of our security guards to Port-au-Prince (3 hrs away) to buy the part, return the same day, and then have a mechanic replace it. Talk about an easy fix.