Friday, March 21, 2014

Beauty Is Everywhere

The night before last we worked a night shift at St. Therese. Glen and I were accompanied by Keri, the doula from Connecticut who we have been blessed to meet and share this trip with, and our translator Shelly.



When the sun sets over St. Therese, the vibe noticeably changes. The unrelenting heat that beats upon the dirt and the concrete, and the thick, heavy stench of dehydrated urine, feces, amniotic fluid, blood, and unbathed, moist bodies give way to the night sky. The scorching sun departs, and the Haitian sky welcomes the moon, which brings a yet still warm night, but one that gives the comfort of an intermittent cool breeze.

The hustle and bustle slowly dissipate as the hours draw by, consistent with the slow but steady drop in temperature. We can feel the difference in the air even in just a couple degrees, and for that, we are thankful. The patients who are here to stay retreat to their beds for not only the comfort of a soft place to lay and potential sleep, but for the protection that the mosquito net brings. Each ward closes its doors, guests and family retreat for the night, and the metal gate to the hospital is shut to the outside world. The moans, yells, and shouts to Jesus of the day no longer occur, but are now replaced with cries that are coming from the new Haitian lives residing in the postpartum unit- the babies that were born today and yesterday.

What I notice for the first time in this sanctuary lull, is the sweet aroma that fills the air. Gone is the invasion of bodily fluids, but now the air is filled with the presence of sweet flowers. It is Heaven on earth. I take deep breaths of the fresh air and I speak to Glen of how beautiful it smells. I wonder why we have never noticed it? Funny how when darkness falls, when your world and heart are quiet, you become more aware of what surrounds you. Beauty is in the little things, yet so often we fail to see them through the busy or the bad of everything else that is occurring. But it's still there.


Earlier today, at about 1pm, a woman in labor walked into the maternity unit. I took one look at her and said to my translator, "That is a big belly for a Haitian belly! She has to have twins." I would bask in my observation skills, as minutes later we would find that she was indeed carrying twins. And term twins at that. Glen did an ultrasound and confirmed that Baby A was vertex and Baby B was breech. She would be 5cm then, and when we returned for the night shift, she had not yet delivered.  At about midnight, I asked if I could check her and found that she was 8cm, Baby A was nearly +3 station, and a tight bulging bag right inside her introitus. I said to Glen and the Haitian midwife in charge that it was bound to burst any minute and I felt it would be better to rupture it in a controlled fashion, allowing it to leak. I felt the baby would come right away. Seeing as this was twins, Glen was hesitant to do that, and the Haitian midwife said absolutely not, for fear of a cord prolapse. In my mind this was silly at this point, as the baby's head was filling the vagina. I nodded and said ok. I do not deliver twins, as they are outside of the scope of my care. I was not the primary provider, so it was not up to me anyhow. Just my 2 cents. I then told Glen and the midwife to prepare for delivery, as once that bag broke, we would be having babies. While Glen made sure Pitocin was drawn up, clean instruments were out, and the PPV mask was out, I geared up in delivery garb, to help wherever needed. I stood there, feeling how I imagine new Haitian babies must feel- hot in the stagnant heat, yet swaddled in layers of non-breathable clothing. Within minutes a pop and explosion, a powerful burst of amniotic fluid ruptured 3 feet across the room, followed immediately by Baby A's head. I was the only one gowned and gloved. I stepped over and immediately caught Baby A. Glen garbed up in the protective gown and gloves and stepped in for Baby B, as we knew this baby was frank breech. Just a few minutes later, this second baby made her way into the world, rump first, to join her sister. Mom would go on to have a postpartum hemorrhage, which would be controlled with Pitocin and Cytotec. She, and her two new girls, would do just fine.

After mom was stable and moved to the postpartum unit, Glen and I would go to lay down to get some rest. Two hours later, we would hear commotion outside in the corridor. Glen said to me, "We better go out there. I think I heard someone say something about a mom pushing in the car." I grabbed my supplies and ran out to the exterior of the building, Keri and Shelly already two beats ahead of me.

What I see is gut wrenching. There are men lifting a woman from the van, trying to get her into a wheelchair. She is contorting, bucking, violently thrashing, in the black abyss of seizure after seizure. I throw gloves on as I yell over the commotion, "Is she pushing? Did she deliver?!" Shelly says to me that she has already delivered. I yell, "Where is the baby? Is the baby alive?!" I have no idea if she is 24 weeks or 40. IS THE BABY ALIVE?!" I must yell it three more times, as no one hears me, there is such commotion and attention on the violently seizing mom. Finally Shelly says, "Yes, the baby is alive." She is so calm, almost too calm. She talks and moves in slow motion, and I know that this is because her eyes and ears are acclimated to scenes such as this. Shelly points to a man, still in the van, and I see he has a bundle of miscellaneous cloth in his arms- shirts, scarves, I am sure anything they could find to keep the baby warm. I step to the open door of the van- as mom continues to thrash like a wild animal that the men are trying to tame- and I see the blood. There is a sea of red blood on the floor of this van, spilling onto the dry dirt ground that I am standing on. I grab the cloth bundle and prepare in my mind for what I might see. I have no idea what the condition of this baby will be. I take the bundle and immediately something falls down out of the cloth- the placenta hits the filthy, bloody floor of the van, acting as an anchor in this Red Sea. I have no extra hands to pick it up, and I we are tethered to the van. Keri instinctually steps forward as if to grab it for me, but immediately halts, as if in line with the shout in my head that has exclaimed, NO! She realizes, as I realize, that she has no gloves on and is not protected from whatever lies within that blood. She sees a clean, dry towel sitting on the seat, and uses that to pick up the placenta. Together, stride for stride, we walk as quickly as we can back to the maternity unit. The baby is alive and breathing well, has good color, but feels as cool as I imagine a cadaver must feel.

We remove the baby from the sopping wet garments and clamp and cut the cord, detaching the placenta. I look to see what this baby is...she is a girl. It is the least of my concerns, but as I dress her in what I have brought in my backpack, I am sad that all I have are boy clothes. The scene is stark in my mind- a new Haitian baby, whose mother continues to seize in the background, is getting cared for and dressed for the first time by a disheveled, hot mess of an American who is dressing her in boy clothes.

Keri and I would take turns holding her up against ourselves, with an electric warming pad pressed up against her back. This is how we kept her warm, bringing her temperature up from the 95 degrees it was on arrival.

The following day, the mom would be stable, conscious, and alert. Keri and I would go visit with her and help to get her baby girl latched to the breast. The importance of breastfeeding...it can be the difference between life or death here. To see a woman who I thought may very well die just the night before, now alive and nursing her baby, this was amazing. Even in a room overflowing with sadness and terrible things, this was a beautiful, wonderful thing to see and to be a part of.

There is beauty everywhere. Even when we are in the midst of bad, even when we are too overwhelmed or busy to take notice.

Thursday, March 20, 2014

Priority of Life

It started like any other morning in Hiche; cereal, coffee, some quiet banter about what everyone was going to do for the day. Tara and I were not supposed to be headed to the hospital until the PM shift-2 to 8pm. We took our time in the morning, getting some relaxation and ultimately looking for something to do to pass the time.

We found out they needed cord ties made. Once 100 were made, they would autoclave them to sterilize them. These cord ties consisted of 3 pieces of string, each 7-8 inches long, rolled up into a ball, then wrapped in paper. Tedious work, but it was keeping us occupied for a few hours.

Suddenly, Nadene comes down with an urgent phone call from Wendy. There was an ectopic on the unit and she was headed to surgery soon and the Haitian OB wanted my help. I took about 2 seconds for me to hop up, gather my gear for the day and head out. My only mistake was forgetting to fill up my water bottle. In this heat, that wasn't a good mistake to make.

The moto ride is usually a casual, leisurely ride from the house. This ride was no different, although I was imagining this mom having a ruptured ectopic and bleeding out as I was taking a gentle stroll though town. I need to go faster!!!

I get to the unit and things seem relatively calm. The OR is on hold because of a general surgery case. I learn later that it is a radical mastectomy being done. Recurrent breast cancer, apparently. I'm shocked to see such a surgery done here. But, I digress. The mom with the ectopic is stable, thankfully. She is obviously in pain, but vitals seem normal and no immediate distress. And due to the delay, it's a good thing she is stable.

I sit and wait for the OR to come get this mom for surgery. I turn my head toward the door because there seems to be some commotion. A mom was being helped in to L&D by two men. She's in pain and sounds like she is in labor. She takes a few steps and blood is pouring from her onto the floor. Flowing from her, steadily running down her legs and onto the already filthy floor...it is truly a horrifying sight to see. Regardless of the cause, she most likely needs to be delivered quickly. First, I find heart tones...baby was alive. Next, I use the crude ultrasound and rule out a previa. I her IV fluids that she walked over with- two IVs hanging- LR and magnesium. Her blood pressure was 170/120. Imagine that...another preeclamptic. Another complication from preeclampsia. There was no doubt she was abrupting and urgently needed to be delivered. But...so did the ectopic. And there was still that pesky mastectomy going on.

I looked at Wendy and said, “This might be very bad. With the delay, we could easily lose all three (meaning the ectopic mom, the pregnant mom and the baby.)” And it could be quickly.

I thought of this were my decision to make, who would be the first priority? The ectopic could go bad quickly, but it also would be a relatively quick surgery. The abruption, though stable at the current moment, had both the lives of mother and baby at stake. There is a prioritization of life being contemplated...and the Haitian OB makes the call that the ectopic gets to go first.

A bubbly, Hispanic guy named 'Romero' came bounding into L&D and introduced himself. It turns our Romero is our anesthesiologist. He has come to see the ectopic. I assumed at this point that the general surgery case is done. I was wrong! Romero left the OR, came to see the ectopic, got her back to the OR and placed her spinal, all while the mastectomy was taking place. As crazy as it sounds, that is exactly what needed to happen here. Time was ticking and there was none to be spared if a life was not to be lost.

I am doing the ectopic with Jean Baptiste, the only other Haitian OB that I had not yet met. He is a very nice man. You can tell he cares about his work and his patients. As we prepare to begin the case, he reaches over and firmly grabs my hands...holding hands with a man I have just met and whom I do not understand his language, he says a prayer in Creole. This work and situations such as these, transcend the expertise and skill of any surgeon. We need all the help we can get.

We start and as soon as we open her belly we know that it is a ruptured ectopic, blood fills her belly. The right tube was distended and ruptured. We take it out. The left tube was severely damaged and we both agree she may never have kids. My guess is that she had an STD at some point that has ruined her tubes. Sad, but it is the reality.

Ruptured right fallopian tube.



Headed back to L&D I'm hopeful that the abruption mom is still stable. She is, only now we still wait for her turn. This time we do wait for the mastectomy to finish, probably another hour at this point. All together it was nearly 4 hours between when she came in with an 'emergent' reason for delivery and when she actually delivered. Lucky for her, she maintained stabilty for the duration.

Surgery was uneventful. Dr. Celestin let me do the case and it was like any other c-section. Baby did great and mom did great. Her placenta didn't exactly look like an abruption, but her uterus had ecchymosis (bruising) that appeared to be a classic Couvelaire uterus with bleeding into the uterus. A good call to deliver by section. And a tubal after this her 10th baby was also done.

By this time, Tara and Kerri (a doula from Connecticut) had arrived to work the PM shift. Things were oddly quiet for a while. As it usually happens, more commotion. This time it is several men and one tiny woman carrying in a mom on a stretcher. It was her first baby. She was 30 weeks by their discussion, but looked more close to term. She had been in labor and had been under the care of a Matron (a local, traditional birth attendant) and she had apparently seized several times prior to being brought to the hospital.

Matrons are traditional birth attendants. These are both men and women that have grown up watching others in their village attend births. They have learned their skills by observation, being taught be matrons before them, folk lore, and probably a bit of voo doo thrown in for good measure. Matrons often have had no formal training in birth at all. Yet, because of the long history of using matrons, these women are very much a trusted part of the community. (Midwives for Haiti has begun a series of classes to teach the basic medical skills needed to provide safer care to the women in these remote village without access to midwives.)

On first evaluation, her blood pressure was 140/120, baby's heart beat was 120 and she was complete and plus 2. All in all, she was pretty stable. She continues to labor as the midwives work to start her IV, hang magnesium, and wait for her to deliver. Over the next hour or so, it becomes clear that her seizures have left her exhausted and her pushing efforts are non-existent. Tara wonders and questions o the Haitian midwife whether a section would be in order at this point. She unobtrusively asks how long they will wait before making that decision. In her mind, I can see the reasoning. A first time mom who has knowingly seized several times and while now arguably relatively stable, she is not coherent and hardly conscious. I can tell she feels this should be happening. One of the Haitian OB doctors checks the patient and says that he will give her a bit more time before ordering pitocin.

I can't say that listening to heart tones is a regular thing here. There doesn't seem to be a protocol. We tried as best as possible to listen consistently every 20-30 minutes, but in an environment of chaos and a lack of staff, it is difficult. In this case, we listen and find the heart rate in the 70s! It stays in the 70s. We set in motion the means to get a section done. I notify the anesthesiologist, the midwives call the Haitian OB. The heart tones have come up a bit to the 100s, but are still low. I was very surprised, pleasantly surprised, that things went very quickly towards section. Within minutes of my notification the OR was in the room to get her. Within a few more minutes she was off to the OR. In the OR, she had a spinal placed mostly on her side, but I'm fairly certain that he nearly put it in with her on her belly. For those that know OB anesthesia, you'll know this is no easy task when they can't sit straight up or lie still on their side.

The only thing missing was the Haitian OB. Once her spinal was in, the anesthesiologist and scrub tech yell at me and motion for me to just start. “You...go!!!' Hesitantly, not wanting to break any rules we agreed on at the beginning of the week, I decide to scrub. It is either that, or we might lose this baby. Just as I'm prepping the belly, the Haitian OB walks in and motions for me to continue. It looks like I'm on my own. He doesn't scrub.

I quickly get to the uterus and open it. Mec...lots and lots of thick meconium. Not terribly unexpected, but also not a great indicator of what I'll find. The baby was limp and apparently lifeless. I knew, however, that there was a set up for resucitation handy, just in another room. I quickly hand the baby off and finish the section. All is well with the mom. I find out that the baby has actually done well. Initial heart rate was 130 and only needed bag mask to get started.

All in all, a busy day. I have found that the willingness to call for a pediatric nurse and have them called for every birth has truly been a life saver. There is no doubt in my mind that without a skilled pediatric nurse for this last baby, that she would have died. For that one change since we were here last, I am grateful, as well as proud of this program. There is change being made.

Until tomorrow.

Glen

Tuesday, March 18, 2014

Sweat, Dirt, and Love


The room Glen and are staying in while here with Midwives for Haiti is a small room that, on our arrival, had a twin bed and a single mosquito net canopy above it. Acknowledging that Glen and I are two people- husband and wife, it was offered that another twin size bed be carried into the room and placed beside the existing twin bed. The first night we arrived, this is what was done. Glen and Steve moved an entire bed from one room to the other, all so that we would have a comfortable place to sleep, together. I joked to Glen that having a bed big enough to share was the least of my concerns. I came to Haiti to work, not to make love or to cuddle. And besides, the idea of being pressed up against a hot, sticky body was not appealing to me.

I thought about this as we drove through the streets of Hinche. Riding on a moto or in the back of a jeep through the unforgiving, unpaved dirt roads, you see the rickety, tattered shacks that are the homes to the people in this town. I found myself wondering about the lives of the men and women and families that live there. I thought of my own relationship and life with my husband and wondered if those personal, intimate moments in life could possibly be the same here? Does the woman and her husband lay in bed and discuss their life? Do they hope and dream and plan for the future? Do they make love to purposely make a baby? Or is the prospect of adding another baby scary? Is it a burden...is it another mouth to feed? What does that life look like from within those dilapidated walls? A home that is not even a glorified shack. A home made of wood scraps, branches, dirt, metal, or if you have more than most, cement. Do they lay beside each other in the hot darkness...cloaked in sweat, dirt, and love? Does he whisper to her that she is the most beautiful thing in the world and that he loves her? Do they lay against each other and make love in their one-room windowless hut as their other kids or family members sleep just feet away? Do they have any idea how different life is for so many people...

It is simple to look at Haiti this way, to compare it to what we have back home, and inaccurately conclude that families must feel this way. But the reality is, we are all the same in basic ways, are we not? We put stake in the future by way of hope, we work hard to survive but also to improve and rise above from where we are, and we all make plans for the future. Why would Haitians be any different? Our life's treasures are not what we own, nor what we hold of monetary value and possession, but the family we create, the relationships we form, and the lessons we pass on to these people and in turn, the world. I suppose even in a country as Haiti, where access to the seemingly simple, basic necessities of life are not guaranteed, where pregnancy and birth carry the very real potential of death, the magnificent reprieve is that of Life and Love.




Today was our first day of work. Glen went to the hospital to help the Haitian OBs and midwives wherever needed, and I went on a mobile clinic to a town about an hour outside of Hinche. The mobile clinic goes to this particular location once a month. This enables the women and babies in this particular area to have access to quality care once a month, when before Midwives For Haiti came here, most went without. Without transportation and expendable money to be used on a 'tap-tap,' women simply could not reach a doctor or midwife.

The new Midwives for Haiti Landcruiser, which we donated toward. 


We arrived to find that the house and church which was to be used as the mobile clinic site was locked up, with no way to access it. Women and babies had already lined up, waiting on our arrival and anticipating to be seen. Something so trivial as having no access to the building was not going to make us skip a beat. These women and babies needed to be seen. A couple midwives walked around the property and found a wooden picnic bench. This would be where the women would sit and wait for their turn to be seen. There was a permanent, cement table placed in the center of the shaded veranda, where the midwives would then make a makeshift pharmacy and urine dipping station. Meanwhile, someone set up the portable exam table that we had brought along with us. A backpack strapped to my back, a doppler on my waistband, stethoscope around my neck, I placed my measuring tape, doppler gel, and blood pressure cuff on the exam table to make my "exam room." A basic set up with minimal supplies, out in the middle of nowhere Haiti, and we were equipped to save a life by way of preventative care, education, and screening.

Keri and I. She's an American doula.

This is where we hosted our clinic.

My 'exam room.'


The morning proved to be uneventful. I went from woman to woman sitting on the wooden bench and took each woman's blood pressure. I was honestly astounded by the beauty of each reading...105/60, 110/60...I'm not sure I had seen such great (normal!) blood pressures during our last trip. I made it a point to tell each of these women how great their blood pressure was, how their baby palpated head down, how wonderfully and completely normal they were measuring. Throughout the late morning patients, a young boy would come up to me, eagerly searching for conversation in his broken English. "Allo, what is your name," he asked me? "My name is Tara," I told him.
"How old are you?" He answered that he was 15. "How old are YOU," he asked me? I smiled at that. "I'm 30." I thought about it more and laughed. "Ha! I'm twice your age...15x2!" He laughed with me at that. I was puzzled at his presence. "Why are you here? Obviously you are not pregnant." (He laughed at this.) He responded saying, "I am here to be a guest!" Okaaaay. I wondered why in the world a 15 year old boy would come here to hang out...to watch pregnant women and busy midwives meander around in the hot sun, as if it were entertaining? Very puzzling to me, but I shrugged and went about my business, smiling at the oddity.

The mild morning warmth quickly stretched into the blazing afternoon, and the steady stream of patients became just a few remaining. One of the last remaining patients got up on the exam table.

"Bonjou! My name is Tara, I'm a midwife. As I began to talk, I instinctively put my hands on her belly feeling as I spoke. Her soft, stretched, gravid belly reminds me of a momma who has carried 10 babies within her throughout her life.

"What baby is this for you?"
"It is my 4th."
It creeps into my mind...she is expecting her 4th baby, just like me. We are two women, in the same phase of life. She is like me. I am like her. Yet so far...

"How are you feeling?"
"OK", she responds, after my translator has translated what I have said to her.
"When are you due," I ask?
"April," she says.
"Is your baby active?"
"Yes."
"Do you have any complaints...headaches?"
"Yes," she says, I have had a headache for 3 weeks."
Hmmm.
"Are you having any visual disturbances?"
"Yes, I have been seeing spots for 3 weeks," she tells me.
"What was her blood pressure," I ask Pleasure, my interpreter?

He rummages through the paperwork I've just been given by one of the midwives, who took her blood pressure a few moments ago, with an automatic cuff.
Pleasure points to a number, and even though I shouldn't be surprised, I am.

It says 210/110.

I quickly finish examining her...I note no edema, I measure her and she measures appropriately, I palpate and the baby is head down...and then I listen, hesitating in my mind because blood pressure like that makes me wonder if baby is even still alive. It is. I tell her that her blood pressure was very high and that I would like to take it again, myself, and manually this time. She sits up and I put the cuff on. When I hear the first beat and when I hear the last, I am yet again surprised. There is NO WAY her blood pressure is what I think it is. I have to take it again.

I take it again and get the same reading. I have never in my life, even in Haiti, seen a blood pressure this high. I switch arms and I repeat it yet again. It is indeed the same.

240/140. I type those numbers and I honestly cannot wrap my mind around it. If someone would have told me that there was a person with a blood pressure this high, I likely would not believe it. I looked her in the eye and I said to her, "You must go to the hospital." She stared back at me, expression unchanged. I knew she did not understand the severity of the situation. I am sure that is the venom of hypertension...it is silent. It does not hurt. It creeps up and up and up, unbeknownst to the invader, silently destructing and wearing down the body from the inside.

I sat down beside her and my translator translated quickly as I went. I looked her in the eyes, just inches from her face, and this time, I recognize those sweet eyes. They belong to that boy. The 15 year old who wants to be a doctor, who was half my age, who was talkative and silly. He belongs to her. She is his mother.

"You MUST go to the hospital, right away. Blood pressure this high can cause you to have a stroke, can cause you to lose the baby, and can kill you. I know it is far, I know nobody wants to go to the hospital...but it is better than dying. Do you understand?"

She looked at me and nodded, and I felt she truly understood. I said to the Haitian midwives, "She needs blood pressure medication right away. Do we have anything?" One midwife brings over some pills, and before she gives them to the woman, she asks her if she has had anything to eat today. The woman says yes, that she had a cracker this morning. A cracker. Nothing more.

I remember the snacks in my bag and I tell her that I have some peanuts in my bag. Would she like some? She eagerly says yes, yes please. I give her the peanuts, brought from Alaska, gifted to me from my dear friend Mary. She sits there like a silent ticking time-bomb, quietly and happily popping honey roasted peanuts into her mouth, and I wonder to myself if she and her baby will make it.

The writing on the tag says, "I do not give lectures or charity. When I give- I give myself." Walt Whitman


I wanted her, so badly, to ride back with us. I wanted to see her arrive to the hospital safely. But, she insisted that she go home to tell her husband where she was going and to get the items she would need for delivery (a sheet, a towel, a bucket, baby clothes). I wondered what all this truly mattered, if it meant further putting her life at risk. What does a baby outfit and a diaper do for a dead baby? My heart sank as we loaded up. I walked over to her, one last time and spoke with her, "I want to see you and your baby healthy. Please do not delay in getting to the hospital. I will be looking for you." She smiled, and we said goodbye- all of us headed down the rugged dirt road, cloaked in sweat and dirt, yet filled with love for this work.


I don't know if she made it to the hospital. I don't know if she will be ok. I don't know if I will ever see her again. But I hope...

Sunday, March 16, 2014

Diplomacy

Diplomacy

Our first full day in Haiti is behind us. We arrived to Port au Prince to find some positive changes. There were new shops in the airport, less 'pushy' men wanting to help you for a buck at the baggage claim. It was a welcome surprise. We met Jackie, a Frontier Nursing School instructor, and quickly made friends. We thought at first that we were going to spend three hours sitting in the airport waiting for the last of our group to arrive, but soon found out there were other plans. We were picked up by Ranel and taken to La Maison Hotel, a quaint little establishment not far from the airport. Two of our friends from our last trip would be headed to Hinche with us this trip and they had spent the night at this hotel. Another friend from our last trip, Sarah, was on her way out, but stayed with us through lunch. It's only our second trip, but we are already making lifelong connections with other volunteers.

Over lunch we discuss past trips, current goings on and our lives in general. We find out that Jackie knows of two of our friends from Alaska through Frontier, she knows a good friend from residency as another instructor at Frontier and an OB residency friend of mine that practices in Athens, GA where she lives. I am struck by what a small world it is. Are we playing a game of 6 degrees of Glen Elrod here? It seems like everyone is either a friend already, or knows someone I know. Crazy!

The trip back is much the same. Dangerous drivers, winding narrow streets. It doesn't look like much has changed in Port au Prince, until we come up to the river bed. The last time I was here I distinctly remember this river bed. There were tent camps still set up from the earthquake in 2010. They are now gone. This WAS an entire city of displaced men and women. Now, they were gone. No sign that they had been there. Nothing really has taken their place, but there were no tent camps. One of the groups say that it has been mentioned that they were simply told to leave. It's not as though they miraculously found housing elsewhere, they were just told they could no longer be there. I'm hopeful that at least some of them found housing.

At the house in Hinche, much is the same. Ina May has had at least two litters of kitten since last we were here and rumor is that she is likely pregnant again. There is commotion from all of the volunteers, some transient, some more long term. The food smells the same. The layout is nearly the same. There is at least one new wall to make an upstairs area a dorm-like room, giving added privacy. The wi-fi has been upgraded and is actually very nice indeed.

In a lot of ways, it seems like we never left. The streets are the same, the people are the same, but behind the scenes, much is different. We, of course, are not in the need to know about the inner workings of Midwives for Haiti or any other agency in Haiti, but we know enough to know that there are significant challenges with the local hospital and other agencies. Typical issues; money, protocols and staffing seem to be a high priority.  
What struck us particularly though, is just how diplomatic everyone is regarding this change. Don't say exactly what you feel because that will likely put an end to your cause. Tread lightly, respectfully, and through small steps you may make change and progress. The system will not change overnight, it simply won't.

One of our friends from last trip, told us about an exciting event at her local hospital. They had asked the staff what they could do to improve their maternity section. One of the options proposed was to build a free standing birth center, staffed and run by nurses but without the 'hospital' extras- IVs, continuous monitoring, and with the option of waterbirth if desired. She talks about the support she got from the hospital, so far as to travel from her home state to Boston to see two working free standing birth centers that operate within a hospital system. But, she also tells of the backlash from the rest of the OB staff for promoting this center. Again, what struck me in her explaining the planning and development of this birth center, is the diplomacy with which she has gone about getting this off the ground.

Maybe we can all learn a bit about diplomacy, not because we are going to become Senators or commanders, but because you 'collect more flies with honey,' as the saying goes. The struggles to provide maternal care in Haiti go well beyond decisions we make on a day in and day out basis in our own practice, but yet we can still learn to do things more diplomatically and with more grace and humility.

Tomorrow starts our full and, hopefully, exciting week. Tara goes off to the mobile clinic and I head to meet with the Chief of Staff to see where I am needed this week. Until then, Bonswa.

Glen



Monday, March 10, 2014

My Own Motivations

Nearly a year and a half ago, I set out on a mission in search of an organization to become a part of, which would enable Glen and I to volunteer ourselves as birth professionals. I had many motivating factors, but the two most prominent was the desire to learn and the desire to give what I feel I could give the most of- my knowledge, my skill as a midwife, my time, myself.

After researching various organizations and regions in the world, I connected with an international non-profit organization who helped facilitate the training of midwives throughout the world, in many different countries. It was my plan to go serve in Uganda. However, as the details began falling into place, we found that not only with Glen being an obstetrician, but a MALE obstetrician, this would not be an option, as culturally this would be very difficult for the women in this particular area. I contemplated going alone and leaving Glen behind for this trip, but in the end, we found ourselves connected with a new organization- Midwives For Haiti. What was profound for me was that Haiti had the same, if not worse, challenges of Uganda, yet it was not half a world away- Haiti was in the back yard of my own country. Do you know how close Haiti is to us? If not, look at a map. That right there is an hour and a half plan ride from Miami. It is amazing how two places in the same world can be so many worlds apart.

So, in March of 2013- nearly exactly a year ago- Glen and I set out on our first volunteer trip to Haiti. If you have not done so already, I encourage you to go back through this blog and read of our journey in that first trip to Haiti. It will sadden you, anger you, but most importantly, inspire you. It will provide understanding as to why we are now preparing to go back.

Serving as a midwife in Haiti by volunteering with Midwives For Haiti is not entirely altruistic. Can it truly be altruistic if I feel the reward of personal gratification? Can it be considered altruistic if I am emotionally and spiritually rewarded by every single interaction I have with the beauty, strength, and faith that is Haiti? No. I go to Haiti because the country of Haiti is in dire need of trained, skilled birth attendants and I- even with little other resources- can help with that. But, I also feel drawn to Haiti for the lessons in life it provides. Haiti speaks to my heart the words which my brain already knows...we are not guaranteed anything in life, any outcome. We have God and eachother and nothing else. Our faith, mentality, and what we do for ourselves and for each other with how much or how little we have truly matters. That is what I know. That is what is reaffirmed to my heart when I think of Haiti.

So now, the night before we begin our journey to Miami and then onward to Haiti, we are almost all packed up and are so very excited! We have two large duffle bags, one filled with new baby gift packs (freezer bags each filled with a receiving blanket, onesie, hat, pair of socks, and a cloth diaper), and the other duffel bag filled with the medical supplies that we will use while there- delivery kits (made up of protective gowns, gloves, cord clamps, gauze, and bulb suctions), sterile needles, IV start kits, alcohol wipes, hand sanitizer, and antihemorrhagic drugs. Glen and I will fit our own personal items in a small carry-on bag. I'll pack a couple pairs of shorts and tanks, a dress for church, a bathing suit, headphones, my iPad, plenty of hair ties, the bare necessities of cosmetics, and a nice cocktail dress, to wear on my 30th birthday while in Miami.

This timing- turning 30, returning to Haiti, the culmination of the past year in mine and Glen's personal and professional life- feels pivotal. I have a lot to say. I hope you take the time to follow on our journey. I look forward to sharing it with you.

Tara