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.  

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.