Monday, April 1, 2013

Day 3 of Haiti, First Day In The Hospital



Liz and I with one of our translators.
Backpack of supplies, ready to get started.

Today was our first day of work at the hospital. We were all (Glen, myself, and the RN volunteer, Liz) very excited and eager to provide care, help the hospital midwives, and see how the Haitian's "do birth."

We arrived at the hospital at 8:30am. Liz gets assigned to antepartum and postpartum, I get assigned to Labor and Delivery, and Glen plans on assisting the one Obstetrician with whatever he needs. Liz's first patient is a mom about 6 months along who is preeclamptic and hasn't felt the baby move in over a day. Glen and I wait outside for our translators and anxiously wonder what exactly Liz concluded with her examination.

As we wait in the corridor of the hospital we listen to the moans of a woman who hardly appears pregnant, but to my ears, seems to be in labor. Her moans are the moans of contractions. I ask our translator what is going on with her. He says he is not sure and asks the midwife. "She is pregnant" is her reply. No other information. I think this must not be good, as she must be severely preterm.
After 15 minutes of not hearing anything from Liz, we decide to go check on her. We find Liz struggling to find hearttones. She's not sure if she has mom or baby's heartbeat. She's a labor and delivery nurse and is not used to using the Doppler. I ask if I can, since of course, the Doppler is all I'm accustomed to using. I feel mom's belly with my hands to try and determine position and I honestly can't make out anything. I can't even palpate a head. So, I put the Doppler on blindly, about where I would expect to get hearttones for a vertex baby. I find the 'heartones' that Liz had found. About 115-120. I honestly can't say if it's mom or baby. I try to find mom's pulse, but she's dehydrated and it's so weak, we can't even make that out. It is fast for mom and slow for baby. I have never understood before how a care provider could get the two confused, but now I see the circumstance how this could happen. Liz takes mom's blood pressure and it is 158/115. Liz talks to the staff midwives about treatment. They had her on mag but discontinued it for reasons we don't understand. They talk about inducing her here and transporting baby to a hospital with a makeshift NICU. We cannot comprehend this. Why would they not transport MOM, with baby still inside? Why did they discontinue blood pressure meds? Makes for a much more stable transport to treat mom, leave baby in for transport, and gives the baby a fighting chance. I don't see how a baby so premature could survive here.

9:15am I leave Liz and Glen behind and arrive on the L&D unit. There is a mom here that is in labor. I ask basic questions relating to pain, headache, visual disturbances bleeding, leaking of fluid, and movement, take her vitals and do a vaginal exam. She's 8cm. I notice the scar on her lower abdomen. She's had a prior c/s.

I'm told there is a postpartum mom here, 15 days post c/s who needs her stitches removed. I've never done this before. The translator assures me she can walk me through it. Oh geez. I've never seen anything like it. It's a jagged vertical incision. I remove the stitches without incident. Mom is well. No complaints.

There is a young girl here who I'm told is "two months" pregnant and miscarrying and needs a D&C. She is splayed out on an exam table moaning, blood clots the size of tennis balls and bleeding everywhere. No one seems to be doing anything. I am aware of my demeanor and know better than to jump in and step on anyone's toes. It creates animosity, as you  might imagine- a foreigner coming in and taking charge, acting as if they know better. I see that the girl has an IV but it is hardly dripping. I quietly go over and open the drip. I take her vitals and I'm relieved they are stable. I push on her boggy belly and a two clots come out, adding to the mess on the bed. I smile and tell her it's ok. I hope to myself that that's all she needed- that all the tissue has passed and her bleeding will stop.

It is hot and humid in the room. The air is stagnant. I'm sweating, going from bedside to bedside with all of my gear on my back in my backpack.

There's another mom here in labor. It's the mom who hardly looks pregnant, that was moaning in the corridor earlier. I ask how many weeks she is and the translator tells me "7 months." "You don't know weeks?" "No. We say months." I explain that weeks is nice because the difference between a 28 week baby and a 32 week is a great difference.
I take her vitals and do a vaginal exam. The baby is so low, my fingers don't have far to go until they touch baby's head. She's 8 cm. My heart sinks and my adrenaline begins to pump. Oh God. I'm about to delivery a very premature baby. I have no idea how many weeks it is. My only somewhat reassurance is that the head actually feels decent size. Where is Glen? Where is Liz? WHERE is the resuscitation equipment? Hell, where is ANYTHING?!? My mind is racing, I'm trying to prepare for this seemingly imminent preterm delivery. It's do or die. Quite literally. I get my thoughts together and ask the translator to tell her that she is going to have her baby soon.

A few minutes go by and we receive the patient's chart. It comes to light that the patient is actually 38 weeks. "THANK GOD!" I say it out loud.

The two month miscarriage continues to bleed. We are still waiting on the doctor to do a D&C.

Another post c/s mom, this one 21 days postpartum. The incision looks better than the last mom. She complains of an ear infection. Not the anatomy I am familiar with. I have to refer her to someone else.

Liz and Glen show up about 11am and its time to start pushing. Glen informs me that the preeclamptic mom's baby (from this morning) is dead- an IUFD.

My mom in labor keeps repeating a phrase over and over, so I ask the translator what she is saying. "She's saying she doesn't want to do it anymore. She wants a c-section." I smile and chuckle on the inside, knowing that some things can be universal. She says something else and I ask again for it to be translated. "She says she is dying."
I ask for her to translate my words- "Please tell her, 'It's ok. You are not dying. Right when you start to think you are dying, it means you are almost done!'" I rubbed her belly and smiled.
Some more Creole words spoken. "She wants you to rub her belly." I oblige.
Mom starts to fall apart a little and I say, "If you work with your body and push when you have the urge, then we can have a baby and be done." It is translated.
Glen listens to heartones and she's having deep variables. Thankfully baby does recover, but when it's low, it's low. I tell her we need to get serious and push strong with these contractions.
We start to see head and Liz looks around and then looks at me and asks, "Where is the delivery set up?" I say, "Right there" and nod to the "delivery set-up." Glen and I chuckle.

It's scary to Liz because she's never seen birth in this way. She has only seen American hospital birth and within a "teaching hospital" at that- intervened, epiduralized, buffet table of instruments. I am thankful that I am accustomed at having only 3 instruments for delivery. It's all that's needed.

A delivery set up.


We have clamps and scissors, and Pitocin is drawn up.
I'm still confused as to the set up of things. There is nothing but a blanket under mom. Where does everything go? There is no basin, no chux pads. We are going to make a mess, I am sure.



11:30 am, a baby is born. Baby straight to mom's chest, Liz does the assessments, and I give mom a shot of Pit in her thigh. They do active management for everyone.



A beautiful baby boy, no complications. Easy. For me anyway. ;) I made sure the translator told mom I thought she did great. I ask if we could take a picture with her baby. She smiles proudly at this!


Glen sees that the miscarriage patient is still bleeding and says he needs to try and clear the uterus/cervix out. He asks for a light, but there is none. I forgot my headlamp, so I pull out his iPhone and shine the iPhone light inside the girl's vagina. Someone finds him a metal speculum and instruments, and the amount of tissue he pulls out is unreal. Blood is dripping on the floor and I want to take a picture so I never forget this. I have no doubt that he saved her life.


At this point the other mom from this morning who was 8cm (the one with the c-section scar), has been rechecked a few times. Her cervix is swelling and she is now 7cm. Glen seems to think the baby is asynclitic. I have had her on hands and knees and "pancaking," but it has not helped. A section is called. There is no other mom in labor, and theings have settled down a bit. I leave Glen and Liz to do the section with the Haitian OB, and head back to the guesthouse to eat lunch. It has been such a busy day!

We are now fed, rested, and ready to get on a motorcycle and head to town to check out a local store. I am hoping to find a bottle of wine!

Until tomorrow...


8:30 Arrive at the hospital. Liz is assigned to antepartum and postpartum. Her first patient is a mom about 6 months who is preeclamptic and hasn't felt the baby move. Glen and I wait outside for our assignments and anxiously wonder what exactly Liz concluded with her examination.
As we wait in the corridor of the hospital we listen to the moans of a woman who hardly appears pregnant, but to my ears, seems to be. Her moans are the moans of contractions. I ask our translator what is going on with her. He says he is not sure and asks the midwife. "She is pregnant" is her reply. Not any other information. I think this must not be good, as she must be severely preterm.
After 15 minutes of not hearing anything from Liz, we decide to go check on her. We find Liz struggling to find hearttones. She's not sure if she has mom or baby's heartbeat. She's a labor and delivery nurse and is not used to using the Doppler. I ask if I can, since of course, the Doppler is all I'm accustomed using. I feel mom's belly with my hands to try and determine position and I honestly can't make out anything. I can't even palpate a head. So, I put the Doppler on blindly, about where I would expect to get hearttones for a vertex baby. I find the heartones that Liz had found. About 115-120. I honestly can't say if its mom or baby. I try to find mom's pulse, but she's dehydrated and it's so weak, we can't even make that out. It is fast for mom and slow for baby. I never understood before how a care provider could get the two confused, but now I see the circumstance how this could happen. Liz takes mom's blood pressure and it is 158/115. Liz talks to the staff midwives about treatment. They had her on mag but discontinued it for reasons we don't understand. They talk about inducing her here and transporting baby to a hospital with a makeshift NICU. We cannot comprehend this. Why would they not transport MOM, with baby still inside? Makes for a much more stable transport and gives the baby a fighting chance. I don't see how a baby so premature could survive here.
9:15 I leave Liz and Glen behind and Arrive on the L&D unit. There is a mom here that is in labor. I take a quick, basic history, take her vitals and check her. She's 8. I notice the scar on her lower abdomen. She's had a prior c/s.
I'm told there is a postpartum mom here, 15 days post c/s who needs her stitches removed. I've never done this before. The translator assures me she can walk me through it. I've never seen anything like it. It's a jagged vertical incision. I remove the stitches without incident. Mom is well. No complaints.
There's another mom here. It's the mom who hardly looks pregnant, that was in the corridor earlier. I ask how many weeks she is and the translator tells me "7 months." "You don't know weeks?" "No. We say months." I explain that weeks is nice because the difference between a 28 week baby and a 32 week is a great difference.
I take her vitals and check her. The baby is right there. She's 8 cm. my heart sinks and my adrenaline begins to pump. Oh God. I'm about to delivery a very, premature baby. I have no idea how many weeks it is. My only somewhat reassurance is that the head actually feels decent size. Where is Glen? Where is Liz? WHERE is the resuscitation equipment? Hell, where is ANYTHING? It's do or die. Quite literally.
And then they get the patient's chart and it comes to light that the patient is actually 38 weeks. Thank GOD! I say it out loud.
Another post c/s mom, this one 21 days postpartum. The incision looks better than the last mom. She complains of an ear infection. Not the anatomy part I am familiar with. I have to refer her to someone else.
Liz and Glen show up about 11am and its time to start pushing. Mom keeps repeating a phrase over and over, so i ask the translator what she is saying. "She's saying she doesn't want to do it anymore. She wants a c-section." I smile and chuckle on the inside, knowing that some things can be universal. She says something else and I ask again for it to be translated. "She says she is dying."
I ask for her to translate my words- "please tell her, 'It's ok. You are not dying. Right when you start to think you are dying, it means you are almost done!'" I rubbed her belly and smiled.
Some more Creole words spoken. "She wants you to rub her belly." I oblige.
Mom starts to fall apart a little and I say, "If you work with your body and push when you have the urge, then we can have a baby and be done." It is translated.
Glen listens to heartones and she's having deep variables. Thankfully baby does recover, but when it's low, it's low. I tell her we need to get serious and push strong with these contractions.
We start to see head and Liz looks around and then looks at me and asks, "Where is the delivery set up?" I say, "Right there" and nod to the "delivery set-up." Glen and I chuckle. It's scary to Liz because she's never seen birth in this way. She has only seen American hospital birth- intervened, epiduralized, buffet table of instruments. I am thankful that I am accustomed at having only 3 instruments for delivery. It's all that's needed. We have clamps and scissors, and Pitocin is drawn up.
I'm still confused as to the set up of things. There is nothing but a blanket under mom. Where does everything go? There is no basin, no chux pads. We are going to make a mess, I am sure.
11:30 am baby boy born. Baby straight to mom's chest, Liz does the assessments, and I give mom a shot of Pit in her thigh. They do active management for everyone.
A beautiful baby boy, no complications. Easy. For me anyway. ;) I made sure the translator told mom I thought she did great. I ask if we could take a picture with her baby. She smiles proudly!


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