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 now 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. 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 regarding the importance of cultural appropriateness. 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 during birth. 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...photo with permission. |
 |
| 2 kilo budle of love |
 |
| #clothdiapering |
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. |
No comments:
Post a Comment