Friday, September 25, 2015

Blood, Sweat, & Tears...and Love

Often times in life, we are our biggest critic and our own greatest set-back, allowing idealistic perceptions define what is “good enough,” and inevitably, setting our very own limitations. One of my favorite quotes speaks to this thought- “If you limit your choice only to what seems possible or reasonable, you disconnect yourself from what you truly want, and all that is left is a compromise.” (Robert Fritz)

It is not just the rare occasion in which I feel inadequate myself...Am I good enough? Am I competent enough? Am I worthy enough? Does any of what I'm doing matter? I'm tired...I'm scared...I'm unsure. These are a fraction of my own internal limitations. It is a continual effort to remove my own limitations and push myself past these internal barriers. Yes I am good enough. Yes I am competent enough. Yes I am worthy enough. Yes, this matters.

Last night we arrived on the Labor & Delivery unit to a young woman writhing and moaning loudly in pain. She hardly looked pregnant. When I questioned the Haitian midwife on why the patient was there, I was told that the patient was “4 months” pregnant, and had fallen. As I spoke with the patient and took her vitals, I suspected that the patient may be lying about falling. She had no tenderness, no bruises or abrasions. Induced abortions with Cytotec here are rampant- Cytotec is inexpensive and easily obtainable. Whatever the cause- a fall or an intended abortion- the patient's cervix was dilating and she would no doubt be miscarrying. There was nothing we could do. Soon after our arrival, things became more intense, with it apparent that delivery was imminent. I looked to Glen and said, “I can't do this delivery. Will you please do it?” He asked me why and I answered honestly. “I'm scared. I've never seen or touched such an early baby.” I didn't know what to expect. I didn't know what this baby was going to look like. Would this baby come out intact? Damaged? Bloody, gory? I was afraid I did not know how to serve her well. I had no clue, and the unknown is frightening.

As we were expecting an imminent delivery, we would find out from the patient's family who accompanied her to the hospital that she had indeed taken Cytotec. The loss of this baby was intentional.

Around us, all Hell breaks loose. Four patients, all near delivery, are contained in a small room the size of my master bathroom at home. The walls contain the yelling, screaming, moaning, and shouts to Jesus. “Jesus, I am dying!” is exclaimed into the air.

The patient begins pushing and in two pushes, the baby's butt becomes visible, revealing to us that this baby is breech. Glen delivers the butt, legs, and abdomen, and as this limp baby girl hangs out of her mother, she suddenly wiggles and kicks fiercely. Glen and I both startle. Glen looks at me and states the obvious, “THIS BABY IS ALIVE.”

He delivers the baby's head, and places her in my blanketed hands. I gently place the baby on her mother's abdomen, gently wipe her dry, cradle her body in the blanket, and place my stethoscope over her. Her heart rate is strong and steady at 160 beats per minute, and she is making an effort to breathe.

Her heart pounding strongly.
My heart racing wildly.
I am dripping sweat and nauseous, my stomach contorted, feeling as if it is in my throat.
The stagnant air is relieved by a breeze coming through the window from the storm that is brewing outside.
“Camille, can you close the window? I don't want her to be cold.”
Camille closes the window.
Dripping sweat, my back is aching, I'm leaning over listening to the baby girl's heart beat.

I begin to cry and don't even try to refrain myself. Tears are streaming down my face; big fat tears fall to the already saturated, filthy floor beneath us, joining the mom's blood, sweat, urine, and every other patient's blood, sweat, urine, and vomit. This floor knows my sweat well, and now, my tears join it all. This, THIS, is the definition of Blood, Sweat, & Tears.

I am sweating and crying for this baby, and my heart aches so bad for this baby girl that it could bleed for her as well.

She wasn't just “4 months,” she was probably about 22-23 weeks...but she didn't even have a chance. Not here. I cried as I heard her heart beating because I knew I was the first to hear her heart, and I would also be the last. I cried because she was living. I cried because she was dying. I cried because there was nothing I could do. I cried because this didn't have to happen.

I looked to Glen, me having never done this before and not knowing what to expect. “How long will she live?” He says to me that it could be just a few minutes...or a couple hours.

I look into the mother's eyes and tell her that her baby has a heart beat, but will soon die. I ask her if I can hold the baby up on her chest, and wait. She nods yes. This is a big deal. I tell her that I will continue to listen to the baby's heart and will let her know when it stops beating. I ask her to look at her baby. I ask her to touch her baby. I tell her that I'm so, so, so very sorry. There is so much I could say, but right here, right now, it's not appropriate and it doesn't matter anyhow. I want to pray but my mind is not able to assemble any coherent thoughts. I simply say quietly, over and over, “Lord Jesus, please be with this baby; please be with this mother.” I know The Lord doesn't need my words. He knows my thoughts, and knows what is in my heart.

Slowly, the baby's heart would gradually slow...160...130...120...100...and finally, just simply stopped. Over the course of that baby's hour here on earth, she was against her mother, and in my hands, wrapped in not only a blanket from Alaska, but also wrapped in prayer. I said to the patient, “Your baby's heart has stopped.” She cried. I cried.

Eventually, after I had carried the baby away, I placed the baby on the scale, looked her over, and weighed her. I wrapped her gingerly in her blanket, and then placed her in the box that was given to me.

In the beginning, I doubted myself and my ability to do a good job and serve this mother and her baby well. I was fearful. I felt I lacked the “right” words. But in the end, my own expectations and self-imposed limitations didn't matter. In the end, I gave my blood, sweat, & tears...and love. That mattered.

I took my gloves off, washed my hands, and walked away.

Thursday, September 24, 2015

Reverence for Life

Before I write the story of the last shift, I want to first say this: There are many people who have read this blog and who have subsequently saturated us with thanks and praise, pouring us over with statements of what great things we are doing, how selfless this work is, and how we are doing such phenomenal things. While this praise does indeed lift us up and make us feel good, I want to acknowledge that we are doing nothing special, nothing requiring anything but a love and respect for life, and the heart to care. The word 'altruism' comes to mind, and there are times I wonder if true altruism exists. Don't we all do things for a purpose of our own heart and conscience? I cannot say that volunteering my time does not make me feel “good,” simply. That in itself is a selfish reason.

I've recently finished a book that was very insightful. It gives an understanding of early Haiti, how Haiti came to be the Haiti that it is. Mainly, it is the story of an ordinary man and woman, not much unlike you or me, detailing how these two individuals did extraordinary things in Haiti. This book I speak of is called Song of Haiti, which details the lives of Dr. Larimer and Gwen Mellon. The recurrent theme (and purpose of Larry Mellon and his philosophical mentor, Albert Schweitzer) speaks to what draws me to Haiti: “Reverence for Life.”

What is Reverence for Life? It is recognizing the value of all life, with the fundamental principle of morality being that good consists in maintaining, promoting, and enhancing life. I value my life. I value the life of my children. There is nothing more valuable to me than this. I see my own life and the life of my own children here. We are not so different. I value life and the right to live without pain and suffering- no matter in my own country, or half a world away. I it's because of this that I cannot have a skill that I can share and not share it, which I know will save lives and help to ease suffering.

A little girl at the feeding center

“The fundamental fact of human awareness is this: 'I am life that wills to live in the midst of life that wills to live.' A thinking man feels compelled to approach all life with the same reverence he has for his own.” -Albert Schweitzer

Our evening started off rather eventful, and not in the usual way. We rode to the hospital in the usual fashion, riding on the back of a moto. This is something that I fear dearly. The black and white logical thinker that I am, has mulled over many times the various ways that we could come into harm while in Haiti, and I've concluded that the moto is likely the #1 culprit for injury. Further add that we are most often on motos during dark hours- going to the hospital in the evenings after the sun has set, and returning in the morning, before the sun has fully risen. The darkness adds the factor of limited visibility, in addition to the dirt roads entrenched with large stones, rolling and bumping land, that further creates an unstable journey on two wheels. As we were riding to the hospital, I thought to myself, “I wonder if we are going faster each time, or if I am becoming more paranoid?” It was as if Glen read my mind because as soon as I finished my thought, he says out loud, “It seems like the moto drivers are going even faster than before!” Oh Lord, it wasn't just me. Not 1 minute after that, I look forward and see the single headlight of another moto coming straight at us, both us and him going full moto-speed, directly toward each other. I think, “Oh shit, we are going to die,” and instinctively yell out, “SHIT!” My hands fly up to grab the first thing they could grasp onto to brace myself- that being the drivers neck. As I yelled, “SHIT!” I felt my nails sink into the driver's skin. Thankfully both motos slammed on their brakes, bringing us to a halt right before collision. I am also thankful that SHIT wasn't my last word before I died. I apologized profusely to the moto driver, and even though he spoke no English, I am certain he got the gist of what I was trying to convey, as I tapped his neck and said repeatedly, “So sorry!!!!”

Our view from the back of a moto

Planting my feet firmly on the ground, I was relieved to get off the moto and walk the few hundred feet from the outside gates of the hospital compound, to the entrance of the Maternity Ward. As we walked through the hospital grounds, the sky above was thundering and rain started to fall down on us. I stopped just before the metal gate entrance to the ward, and stood there under the falling water. Even in the dark night with a deep blanket of clouds above, the air here remains thick. The cool rain felt good.

We began our night by making rounds on the antepartum, postpartum, and post-op units. These are each one room units, lined with beds on both sides of the room, each bed numbered on the wall above. The first patients we see is a mom and baby. The baby is about a week old and is being watched for a low-grade fever. The first observation is that the baby is swaddled up tightly with a thick winter blanket. It is hot as hell in here, and no one should be using a blanket, baby included. I have no doubt this is likely contributing to her low-grade fever. We take her vitals and do a full assessment. I see that the baby's diaper is full, and note that it is soft, yellow stool. Just as it should be. I help Grandma change the baby's diaper and discover that this baby girl dressed in all pink, actually has a penis. I laugh at my own assumption, because really, using whatever clothing you have is simply practical.

As we are doing our rounds, one of our favorite Haitian midwives Carmell says to us, “I will let you know if we have anyone in labor come in. I know you like to do deliveries!” I smile at that. I know she likes the help, and she is right- I do like birth.

At 9:50pm I catch a baby- a normal vaginal delivery, a healthy mom and healthy baby. As I am finishing up and helping the new mom get cleaned up, Glen listens to heart tones on another patient who is being induced with misoprostol due to severe hypertension. This mom looks terrible and seems to be very sick. Her whole body is extremely swollen, tight from the fluid that is collected in her body. Her face is so swollen that even her eyelids are puffy. I am certain she is nearly unrecognizable from what she normally looks like. Just looking at the woman is a reminder that hypertension in pregnancy is no joke. It may cost this woman her life, or her baby's life. Glen puts the doppler on and we hear clunk.........clunk..........clunk......................clunk. The baby's heart rate is in the 80s and stays there. They reposition her and continue to monitor baby. There's no oxygen available. The baby continues there, sometimes skipping beats. With this mother's hypertension and severe symptoms, along with misoprostol induction, there is no doubt that this baby has little reserve. Glen checks her to see if we are close to delivery and can somehow expedite it. She's only 3 cm. We know that this baby is not going to tolerate labor much longer. He calls a c-section. It's 9:55pm. The Haitian midwives call the Haitian OB. He's busy and can't come. He says that Glen needs to do the c-section. The midwives hang up and jump into action. Within mere minutes, a foley catheter has been placed and the patient is prepped for surgery. Honestly, I'm dumbfounded. I have never seen anything happen so fast in Haiti. There is true urgency in the room, and I have never before witnessed this in Haitian culture. Maybe I'm naïve, but this is my honest observation. Glen tries to listen to the baby again and can't find heart tones again. Is it because of a positional issue or have we lost the baby? We are all wondering the same thing. He continues to try, and nothing is heard. The clock is ticking...ticking...ticking...we wait and the minutes pass by. The Haitian OB who they previously called cannot get a hold of the anesthesiologist, and neither can they. She isn't answering her phone. Glen can't do a c-section without anesthesia. Tick...tick...tick...the minutes are ticking by, and this baby is dying with each tick. Finally, an ambulance arrives to the hospital, and in the ambulance emerges not a patient, but the anesthesiologist and a scrub tech. How interesting that the ambulance brought them to us. As we would find out, this crew is Cuban and only speaks Spanish.

So there they went, an Anesthesiologist and scrub tech who only speak Spanish, an OB and RN who only speak English, and a Haitian O.R. assistant who only speaks Creole. As Glen leaves he shakes his head and tells us that it is inevitably too late. There is no way this baby is still alive. My chest is heavy as I think that we listened to that baby's heart slow down as it gradually stopped beating altogether. I walk to the storage closet, to where Shelly was, and I ask her (as if she were more insightful than I was on the matter), “Do you think the baby is still alive???” I feel as if I am grasping at straws, wanting some reassurance that this little life is still in existence, that we even have a chance. Not just the he or she has a chance, but that yes, WE, have a chance. This life is valued. This life matters. I don't know the swollen face of the mother from any other random face of the day, and I might never know her baby, but in these fleeting minutes, tick, tick, ticking away, there is Reverence for Life.

Shelly looked at me and answered my question. “I don't know...probably not. But I hope so.”

I would walk away to another mom laying on an exam table who was pushing. I would do this delivery by myself, as Glen and Camille were likely just beginning the c-section. I couldn't help but to think that as one life blazed into the world screaming, one life was ending, coming into the world silent. That is a profound feeling. As Glen and Camille would later tell me, Glen would lift the blue, lifeless baby boy from his mom, hand him to Camille. He was certain this was a lifeless baby he was handing over, and contemplated this as he sutured this mom's very sick body back together.

I had just finished with this mom when Camille entered the room with the tiny bundle in her arms, pressed against her body. I heard her say my name, “Tara.” She called it out firmly, not exclaiming but still, making a statement.

I knew when I heard her that the baby was alive. I asked her, “Is the baby breathing?” The baby was trying to breathe, though not very effectively. The conversation between Camille and I is a blur. I took Camille's stethoscope and placed it over the baby's heart and was surprised to hear a heart galloping away; 140 beats per minute. A couple breathes of PPV and some stimulation and this baby was breathing on his own. My fingers remember what that limp body felt like under my fingers. This baby was not even two pounds. So delicate, so frail. We wrapped up this tiny, flopping body who was now making an effort to breathe, and carried him down the hall to the NICU. A pulse ox was placed and showed that his heart rate was 160 bpm and oxygen saturation was 87%. Astounding. We would leave the baby there, under the care of the NICU team. We walked away having done what we could, leaving him in the care of others who will hopefully do what the can.

Meanwhile, we do an intake assessment on a young and very tiny mom whose water has broken. She is a first time mom, looks to be about 100 pounds, and is about 28 weeks pregnant. There is amniotic fluid everywhere- the exam table is drenched, and as Camille and I speak to her, our shoes are in a sea of in her amniotic fluid. She lays on the exam table, without underwear, her legs spread. Her vulva and legs are dripping with fluid, smeared with mucous and blood. I place my hands on her belly, and see that her abdomen hardly looks pregnant. The untrained eye would likely not suspect this naked abdomen to be a pregnant belly. My sweaty, gloved hands could hardly palpate a baby. Her muscles were taut and solid, her skin and muscles from not having held a baby before. Her vitals were normal and her baby sounded fine. She was not contracting. The Haitian midwife had already completed a vaginal exam and said she was 1cm dilated. I went over to the Haitian midwife and asked if we were staring steroids, to help mature the baby's lungs. She shook her head no. I asked why. She said because the patient was already dilated and it was too late, steroids would not be useful. I felt the need to clarify how dilated this mom was, and asked again. She said 1cm. I had so much to say but recalled a good piece of advice that I had just read in the Midwives for Haiti volunteer manual...the best place for questioning something and to correct or teach, isn't in real time, in the clinical setting. This is, after all, their territory, we are just here to help, and teach by example, or when otherwise appropriate. I walked to the back room where Glen was and explained the situation. He agreed that the mom should get steroids and antibiotics. I asked Shelly how I might say this, to let the midwife know, “This is what we would do at home...” Shelly ended up doing a great job with translating this, and in the end, the midwife was very receptive to it, asked Glen the appropriate medicine and dose, and then said she would do it. [The next day we would find out that this mom would subsequently deliver her 28 week breech baby into the hands of another midwife volunteer with Midwives for Haiti. No one knew if the baby was dead or alive, and when the baby's legs were delivered. Jamie was surprised when they started to move. As I write this, the baby is alive and well in the NICU. I hope those steroids got to where they needed to go.]

We would have another delivery later in the night, and this one wouldn't be easy on use either. I wouldn't have expected anything less. The Haitian midwives were taking care of a mom in labor. I had previously told them to just let us know what we could do to help, that we were available if need be. While pushing with the mom, the midwife heard that the baby's heart rate was having decelerations. It would go from 140 to 80...70...and then slowly recover back to baseline. That's not something that we don't sometimes see. Except then she noticed that the baby began to have repetitive decels that were taking longer and longer to recover, now staying a good bit of time in the 70s and then not recovering. She asked for “Dr. Glen” to come help. At this point we were seeing baby's head at the peak of the push, but not crowning. The Haitian midwife asks if Glen can do an episiotomy, but he explains that this will be useless because the baby isn't to the perineum yet. The midwife nods in undertsanding. I see her contemplating something, and as I open my mouth to offer a suggestion, she says the same thing, but in Creole. “What about a vacuum,” we both ask? Glen looks surprised and says, “Oh, do we even HAVE a vacuum?” Why yes, yes we do. I had seen them in the storage closet. He says ok, and a vacuum is retrieved. He puts it on, mom pushes, and he assists her pushing with the traction of the vacuum. A baby girl is born, screaming.

All in all, a busy two days...reminding us and revealing to us in new ways, how delicately precious life is.

Tuesday, September 22, 2015

A Pot to Piss In...and So Much More

Welcome everyone.  If it doesn't become obvious momentarily, I (Glen) have been handed the reigns for today's blog.  Thankfully, I have had a bit of help with the editing to give it a bit more of a writer's flare.  Never fear, I'll make sure Tara picks back up tomorrow!

I'm glad our first day started off so quickly- it gave Camille a taste of what it could be like. But, this last shift would allow us to sit back and take it all in...and that might not be all good. We started the day off nice and slow, such a difference from yesterday, when we literally walked into two simultaneous deliveries. This shift, we were able to help take care of some of the tasks of a busy ward. Tara and Camille set off with our translator to do vitals. Certainly an eclectic mix of antepartum, postpartum, and post-op moms to be seen. One of the most interesting was a mom admitted from mobile clinic for suspected early labor. (Because she lives so far away, she may end up staying there until she delivers.) On exam, Tara noticed something odd about her lower belly. It was obvious she was pregnant, but her bladder was so protruding that it was noticeable with her laying on her back. Tara expressed concern to me; dare I admit Tara's perplexed concern was somewhat comical. She wasn't quite sure what the problem was, as I don't think she had ever seen a bladder so obviously distended. Upon questioning, the patient stated that she did not feel the need to urinate. Tara palpated her abdomen and felt her bladder. The patient didn't flinch, and appeared to not have any discomfort. Clearly though, she had to pee. But where? In what? There are no restroom facilities anywhere. Remember the saying your mom always used to say...'she ain't got a pot to piss in.' I laugh at this...perhaps that was just MY mom, growing up in rural Kentucky. But, I remember hearing it and it never was quite as vivid as here. We found her 'pot,' which was a large bucket that the family had brought with them. Camille held it under the mom as she stood at the side of her bed (not 2 feet from a postpartum mom and baby couplet) and peed. Nearly filled the bucket. You look around and everyone has their pot to piss in...well, everyone except the birth team. Thankfully Tara and Camille somehow have the capacity to hold their bladders for 12 hours. But...that's a different story.

Just when you think that we have everything, or that you can do anything, you're thrown a curveball. Dr. Celestin had apparently seen this young, first-time mom in his outside office and sent her to L&D to get a D&C due to a miscarriage that had not passed. This patient had had consistent bleeding for 8 days that was not slowing down. D&Cs aren't the most glamorous procedures to do here as they are typically done without much in the way of anesthesia and such an invasive procedure which is normally (back home) done in private, is done here in plain view of everyone. Tonight would be no different, except for one twist. As I'm preparing myself for the procedure, I go to the stand beside the patient and look over my instruments. I expect to see all the usual: speculum, tenaculum, dilators, and a currette. Instead, I see no currette and a plastic iPas device. I've seen this manual suction device before, even thought of buying one for use in the office for miscarriages, but this is not my typical go-to device. And here it is in front of me.Thankfully, it wasn't very difficult and all things considered, the D&C went pretty well. Tara stood by the patient's side, holding her hand and caressing her face to help her relax through it, while Camille assisted with holding a leg. One of the Haitian midwives oversaw, and hopefully now could use the iPas device, should she need to. The best part for me was that at the end, the patient looked to Tara, took her hand, and said (in clear English), “Thank You,” for helping get her through it.

Something is brewing in those clouds

It's never fails to amaze me that women come and go in Labor and Delivery here. Somehow, the midwives keep all of these women straight. One such woman had apparently been there all day. When I asked what her status was, the midwife says, 'Dr. Celestin is coming in to section her at some point.' “Why,” I ask? “Transverse lie and her water is broken.”

I decided to examine the mom myself and confirm that the baby is vertex! The baby is “Cephalique” and shouldn't need a cesarean section. A few hours later, Dr. Celestin comes in and does a vaginal exam and doesn't feel a presenting part and finds the head is the right lower quadrant.

In our discussion about abnormal lie (breech, transverse), I ask if anyone there does versions. A 'version' is a procedure where a baby is manually turned to get it to head down. A fairly common procedure in the states, but not here. I ask why they don't at least try- certainly an attempted version is safer than a potential cesarean section- and am told by Dr Jean Baptiste that they learned in training that versions will cause the placenta to pull away and harm the baby. This just goes to show that you just never know what is common sense and commonplace in one place, may be literally a foreign concept somewhere else.

Eventually, we take the patient back for section. Dr. Celestin jokes in Kreyol that I am the primary and HE will be assisting me. Apparently, not only am I the primary surgeon, but the scrub tech as well. I stock the Mayo stand, prep and drape the patient. Everything, except the sharps, eventually winds up between the mom's legs...placenta, retractors, scissors, blood clots...everything. It isn't exactly the prettiest, but it did get the job done. Camille would join Dr. Celestin and I for the cesarean and be responsible for the baby. After delivery, Camille would take the baby to Tara, who was awaiting in Labor & Delivery. I can't say that the protocol for having an assistant in charge of baby's care has been implemented, but as Tara reminded me, we did get to model this for the Haitian providers. An assigned care provider for baby to company during the surgery, and someone waiting, prepared to assist with care on the ward.

Preparation for the c-section baby

As our 4 year old Adria would say, this baby was a 'fat man' (this is her term of endearment for Callen), at a whopping 8lb 13 oz. Except, apparently it is a curse in Haiti to call a baby 'fat' because those 'fat' babies will then lose weight and not thrive or do well. In doing postpartum rounds, Tara proudly exclaimed, “The baby is so fat!” Our translator had to inform her that she should not say this, since it is not a good thing for he family to be told. Lesson learned. No “fat garcon” or “fat tifi” here!

One of the things about birth that we take for granted back home is that women, and our culture as a whole, value and celebrate the 'birth experience' when the baby is born. It has been my experience that moms and dads often cry when their new baby is born. Emotions are abundant with birth in our own culture. However, birth is not typically a time when Haitian women express emotion. Nor are babies often named at birth. We often get asked regarding this by friends, why it seems as though Haitians seem irreverent for new life. While it may appear this way superficially without understanding Haitian culture, we slowly understand that this is not the case. At the very basis, we need to consider and remember that if a baby is born alive, BIRTH is the first of many hurdles that the baby has to cross to get to adulthood. Enough babies die after birth that it seems recognized that the newborn's life may be short-lived.

A baby girl we assisted with permission. 
2 kilo budle of love


I will admit that I was once perplexed over a total lack of emotion in Haitian people, in birth and in death. But last night changed that. In the overall quietness of the night, a spontaneous commotion erupted within the hospital compound. A woman sprung from the dark, exclaiming, yelping, and wailing, making us question whether she was having a mental breakdown. The exterior hallways within the hospital are as pitch black as the night sky, making visibility in trying to visualize the happenings hardly possibility. In the wee hours of the morning, with wards overflowing with admitted patients and no where but the outside for some patients and their families to sleep, the halls are lined with sleeping bodies. The shrill hysteric outcries of this woman startled all of these slumbered bodies, resulting in a scattering of the people that laid surrounding her. What is going on? What is happening? I am sure these were the questions in everyone's mind, us and Haitian alike. The woman's hysterical screams and outcries continue, as random voices yell to her in the dark. Though we had no idea the specifics of the situation, it was obvious that this woman was grieving. One thing is certain, the translation of loss and grief transcends cultural and language differences. As we would learn from our translator, someone had just died in the ICU. The yelling sounded despaired and grieved, and that it was. This was the first overt display of emotion that I had witnessed in Haiti. Through the pain of labor, the separation of family, the death of a child, nothing we had previously seen provided a glimpse into one's personal feelings of their pain and suffering.

As those of this blog would know, hypertension in Haiti has been rampant in our previous trips. As we take vitals in labor I'm amazed that more often than not, the women have had normal blood pressures. Obviously there has not been a dramatic change in diet, but perhaps an increase in prenatal and intrapartum care availability? This of course is anecdotal... I don't know the answer, but it is very apparent that something is changing. 

Sunrise behind the Midwives for Haiti compound.

Monday, September 21, 2015

Haiti 2015: Day 1 & 2

We arrived into Port-Au-Prince on Saturday afternoon and made the long, winding journey to Hinche by way of the Midwives for Haiti Land Cruiser. I will admit that I was a bit excited about the travel accomodations, as we have always received transportation in the classic, "Pink Jeep." The enclosed air conditioned vehicle was a welcome repreive from our 20 hours of travel from Alaska, and especially knowing how I get with motion sickness. We would, however, find out that the air conditioner isn't functional. Ha! We packed into the back of the Land Cruiser and within about 20 minutes the first passenger was feeling sick. Thankfully, it wasn't me (yet). I got out the peppermint oil from my purse and Glen got out a rag, which we wet and put on the back of the other volunteer's neck. The rest of us rubbed peppermint on the backs of our necks to help us cool down. The cooling sensation felt amazing in the dense heat we were sitting in. Of course not long after that, I was the next victim of the trecherous journey. The constant swerves, bumps, and horns ablaze from other vehicles flashing by was taxing on my senses and internal stamina. I quickly turned 'green,' earning myself a front seat accomodation, right alongside our driver. I laid back in my seat, splashed water on my face, closed my eyes, and let the wind blow in my face. 2 1/2 hours from that point, we had made it safely to Hinche, and I had made it without did Lea, my partner in sickness

Sunday was our first full day here, and the beginning of a night shift at St. Therese. A group of us rode on motos into town and attended church service.
Volunteers Lea and Shelly

After church Glen and Camille (our clinic RN back at home, who joined us this trip) took a tour of Hinche. I stayed behind to rest and gear up for night shift. Camille would return, slightly aghast, telling stories of the food she saw in the open market- fruits, meats, fish, all swarming with flies. She held serious concern for Glen, and made sure to report back that he had been eating these items, without concern for what might subsequently happen from ingesting flies and larvae. Glen assured us that it was delicious and he was fine. 20 minutes later I was downstairs eating a late lunch and Camille came flying into the dining area, wide-eyed, as if she had just seen a ghost. She said to me, very much an exclamation rather than a question (because she already knew the answer), "Tara! WHERE IS DR. ELROD!?" (It's funny to me that more times than not, she still refers to him as 'Doctor Elrod,' rather than Glen.)

Amusingly, I had already heard him from downstairs and knew exactly where he was. He is, afterall, the world's loudest puker. I responded with, "Oh, he's upstairs puking." Camille's eyes were as wide as saucers, and just like that, it pretty much validated Camille's hesitance to consume anything out of the ordinary. But don't worry about was delicious...and he's fine. ;-)
Glen trying some dried herring in the marketplace.

We arrived to the hospital shortly after 7:00pm, and within minutes had assisted with two deliveries. The first baby the Haitian midwife delivered, Camille and I would assist, and Glen would subsequently suture the mom's laceration. Camille helped to stimulate the baby and I tied the cord with string. Camille would do the newborn exam and dress the baby, all while Glen and I pushed with the mom 5 feet in front of the first mom who delivered. As Camille was doing the newborn exam, she noticed that it was oozing and had to re-tie it, tighter than what I had tied. Good catch, Camille.

The postpartum mom would lay there on her own delivery table, legs sprawled and perineum torn, raw from just having given birth, quitely observing the other woman preparing to do the same. I stepped over to her and made sure she understood, "We don't want to start to suture you right now, so that we are prepared for this baby. As soon as this baby is born, we will get you sutured and dressed." She smiled and nodded, appreciating the explanation. Camille took her vitals and tended to the baby while Glen and I assisted the other mom. The Haitian midwife charted, and attended to the other packed room of laboring women.
Camille and a new Haitian life
A healthy baby girl

The mom who was pushing had fetal heart tones in the 60s, telling us that baby was not doing well. Glen ruptured the bag of water (and as amnihooks are a luxury, the tool that the Haitian's use to AROM (artificial rupture of membranes) is a needle or the back of the needle cap). The Haitian midwife, Carmelle, joined us in telling the patient to push as hard as she could. "PUSH HARD! KEEP PUSHING, GO ON, PUSH! YES, JUST LIKE THAT...KEEP GOING...GO, GO, GO...PUSH!" These were the sounds now coming from the Maternity Ward. A 2.9 kg baby boy was born, needing stimulation and a couple cuffs of PPV. Mom was expecting a girl and had only brought a girl outfit to put baby in. Not that it would have been the end of the world to dress him up in a pink outfit, but I thought it a better idea to use a baby gift pack. This particular mom had brought a cloth pad but did not have any underwear to put that pad in and keep it in place. I was wishing I had thought to bring a stash of underwear. I think that would be a great addition to our packs next time.

After these two deliveries, we realized that there were no more syringes for Pitocin or Lidocaine, as well as no more Vitamin K. We searched everywhere, and ended up having to resort to putting Pitocin in the 1mL syringes that are typically used for Vitamin K.

7 hours into our shift and it was a bit quiet, with 4 babies delivered and no one imminitently delivering. We all retreated to the storage room, which also doubles as a break room for the midwives and volunteers. We intermittently talked, rested, and checked on the women who remained in Labor & Delivery. Over the course of the night we participated in 4 deliveries, with the Haitian midwife doing another delivery as we rested.

As an outsider coming to Haiti, it is so easy to feel sadness, despair, frustration, and helplessness. Nights like tonight are a welcomed blessing, showing us the good, the life, the hope...A competent and compassionate skilled birth attendant that is the product of Midwives for Haiti. Healthy, term babies. Perhaps it was a smooth initiation to preserve Camille. Either way, it was good to see the good.

In my time here and life since my first trip to Haiti, it seems that the feelings of sadness, despair, frustration, and helplessness are necessary: they are catalysts for change, afterall. Can you imagine a world in which we turn a blind eye and guarded heart to the pain and suffering that exists? Just because it is not happening where we are, does not mean it is not happening. I type that from my laptop and you read that from your computer screen or iphone. Human pain and suffering can be mentally comprehended, but to really GET IT, and act on it...that's a different challenge. More on that later.

Until next time...