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.