THANK YOU

Some of the staff waiting for the rest to arrive.

Only a few days left before heading to the “other side,” as Haitians like to refer to the United States. I have been letting everyone down here that I know that I will be leaving this week. My friends and acquaintances ask, “forever?” No, I will always be coming back and that is the truth.

Marie and her 4mth old! She works on our mobile clinic.

Brittany has been doing a fabulous job taking all of the inherited roles and responsibilities in stride. We have been skipping between meetings, errands in town, and to the gritty details of the “how-to” of the daily and monthly routines. I remember how everything had been so new to me – the sights, the language, the people and customs. The experience of delving into a new culture and learning on-the-job is irreplaceable. I do believe that this year in Haiti has been the best year of my life yet in terms of growth and self-realization. I couldn’t have asked for a better organization, staff, and introduction to Haitian culture.

Posing with all but one of the mobile clinic staff.

So, now that it is time to pack up my bags, I am feeling a bit overwhelmed by the realization of going through another change... acclimating to life in the U.S. I am anticipating the transition, and so I plan to keep busy as soon as I arrive. Nothing like starting a new job to keep your mind preoccupied!

Eliot (cleaning lady), Solimen (cook), and Dieuny (cook). 

Today, Father's Day, I scheduled a staff party for the Midwives For Haiti in-country staff. MFH has parties every so often to celebrate the midwives, the students, etc. but never just the staff (at least not since I have been here)! So, I felt that it was important to recognize the people who do all of the behind-the-scenes work. The ones who aren't necessarily catching babies and attending to pregnant women, but the ones who make it all happen in between. I've included some pictures! The afternoon went very well (though we did start an hour and a half late). Here I am one year in Haiti, and I still expect people to come on time!

My good friend Mirline, one of our instructors.
She is a nurse midwife.

Just about all of our translators. They spend hours following
our midwives and nurses in hot and sticky hospitals
and clinics. 

How do I describe the wave of emotions while telling all of my colleagues how life-changing they have been to me? I did make it through my speech tear-free, but I so wanted to reach out to every one of my Haitian friends with open arms. Mwen genyen yon plac nan kè mwen pou chak moun. I have a place in my heart for each person. Thank you Midwives For Haiti. Thank you Haiti and to everyone that I mentioned today. Brittany, you will do a great job. I have no doubts. Thank you to my followers for your support. This is my last post. 

Patience is a virtue

The bedroom I am leaving (that is a mosquito
hanging above the bed). 

I am a naturally impatient person. That is not an excuse for anything, but it is simply something that I struggle with. I want to say I had one of my final tests (though Haiti has been one big test) on my patience tolerance.

One of the nursing students putting baby
packets together.

We need to buy a generator for our birth center halfway between Port-au-Prince and Hinche. Sounds simple, right? The 15kw generator has to be ordered at the Valerio Canez extension office (a wanna-be Lowe’s) in Hinche. I had no idea what kind of generator I was to expect for our needs, but what I did learn was that the bigger the object the more difficult the order became. I think I made three trips to the office in town before I finally got somewhere.

Our dining room in the Guesthouse.

How much I am looking forward to moving back to a more wireless world! The internet would have been nice to have had for the transaction. The office couldn’t process the credit card, or they didn’t have the bank account number ready for the transaction, or the costs for shipping and handling weren’t finalized. Let’s just say that there is no concept of customer service. Why should there be though? If a buyer really wants to purchase something, it is up to them to make it happen. No one caters to the other in a business deal such as this.

Our classroom.

The UNH nursing students with our Creole teacher, Kenel Pierre.

Aside from that mess, I had a good week with a group of nursing students from the University of New Hampshire and getting ready for Brittany’s arrival. She just got in on Saturday. The training has begun! She is excited to be here and eager to pick up where I am leaving off. I have full confidence in her! Though I will be sad to leave, I wouldn’t want her to miss out on the privilege of working for such a mission as MFH’s nor experiencing the hidden beauty of Haiti. I smile at the thought of her having this opportunity.  

Getting the message

I’ve been reading this book called African Friends and Money Matters by David Maranz, an ethnographer who has lived on the continent for many years. The book addresses the systems, customs, and behaviors of Africans and how Westerners have misinterpreted them to the point of viewing African culture as not just different but “lesser” compared to their own culture.

Haiti is not Africa, but it does trace its roots to the Western shores of the continent when the slave trade began. I have found many similarities between the cultures and have found the text very helpful in viewing Haitian culture in a new light. 

So, as I am nearing my departure, I have a few mental notes that I want to take away from the culture illustrated in the book in the hopes that I will prevent unnecessary frustrations next I return.

One is that Haitians never give a frank “no” when disagreeing with or refusing something. For example, Haitians frequently ask each other (and Westerners) to borrow money. If someone cannot lend any money, their response to the inquirer may be, “How about you come tomorrow, and we can talk then?” or “If I hadn’t spent my money on my rent, I would happily give you some”. With these seemingly circuitous answers, the person denying the request shows respect and solidarity to the inquirer. The relationship is maintained and neither side leaves feeling embarrassed.

It has taken me until a few weeks ago (when I finally cracked open the book) to realize the importance of this form of “dialogue” rather than using the American form of “direct communication”.

Another take home message is one involving house calls. I frequently would get annoyed when staff or other unannounced visitors would show up at the house requesting a meeting. Sometimes, it would be 7:30am or 7:30pm. Not to be rude, I would stop what I was doing to meet with the visitor. But, I had been missing something about these house calls all along. In Africa and in Haiti, having a lot of friends or acquaintances gives one status and respect in his community and also is a sign of respect to the one visited. Visiting friends and employers, therefore, is important to developing or maintaining a social network on which the visitor can depend in times of need.

I was on the phone yesterday with one of our employees, and because she couldn’t hear everything that I was saying, she said she would just come to the house to talk about it. It would only take two minutes, but the employee made the effort to come out to meet me to discuss what I had to share.

It’s amazing to me how long I have spent in-country and was not able to pick-up on these cultural nuances. Well, now I know!

New Introductions

Here's a proud mom! Marie Ange, one of our mobile clinic midwives,
delivered two weeks ago to a beautiful baby girl, Christ-Nérie.

Visiting with Jamlecks, our cook's 3 yr old son.

Happy Mother’s Day! Today Haiti celebrates “Fête des Mères”. I went to Maison Fortune Orphanage this morning for the Sunday Mass. It also happened to be the celebration of the Trinity – a two in one celebration.  Following the service, two of the resident boys shared a “Mother’s Day Rap” song with the congregation. “My mother, she is my entire heart, I love her!” And, this was coming from a young man who may not even have one.

One of the volunteers helping the students estimate
blood loss after a delivery. It's food coloring!

The rainy season is in full force now. We get drenches just about every night. The roads deepen with mud, the porches become lakes, but the gardens begin to grow! This is a green time for Haiti.

Midwifery is not for the faint of heart.

My friends and coworkers are beginning to lament my going away! I guess that is a good sign. The mobile clinic midwives (the ones who go to remote locations four days a week to provide pre and post natal care to hundreds of women a month) tell me that they are going to miss my “sense of responsibility.” The cook tells me that she will miss my daily morning greeting. Others ask if my replacement is going to be like me! Well, she won’t be me, but I think she will be better! Her name is Brittany Tusing. She just graduated from Johns Hopkins University with a major in Molecular and Cellular Biology and a minor in French (just like me!). I met her in January, and I think she is a great fit for the job! I will be training her when she comes in two weeks. We have some overlap together. I am beginning to write-up a job manual for her. It is eight pages long and growing…

So, what’s next? Brittany will be taking my role obviously. I am happy to say that she will be receiving a monthly stipend. So, the “In-Country Coordinator” is no longer a volunteer job! The Directors have seen the improvement in the program by having someone providing oversight and continuity.

Practicing their suturing (for vaginal tears).

I will be taking MFH’s only full-employed position as their new Administrative Coordinator. I am flying back June 19^th and begin training on the 24^th in Richmond, VA. Wow, has time flied!

I appreciate everyone who has taken an interest in this blog. I have a few more posts left, but I am not sure if I will continue it while I am in Richmond. Not as exotic as Hinche, Haiti to most, but for someone coming from a military school and a developing country, it will be for me!

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.