Emotions

I stood out under the rain tonight. Stood out under the dark black sky, opened my arms wide, and let the torrential downpour fall on me. It was a contradictory of feelings- it felt surreeal, like something out of some dramedy- but yet it felt so real. This is real life. Shit got real about a week ago. And I'm not sure it gets any more real than this.

I let two tears escape me tonight as we rode home from the hospital. I hate that.

I'm a feeler. I feel more than anything. I work with my mind but also very much with my heart. But I'm also a realist. I'm not one to cry over something I was expecting...something I was prepared for and anticipating. I wasn't expecting to cry over things I know I cannot change. At least not change right here, right now. But yet it happened.

I spent the night with a 15-year-old laboring mom. I had no translator and no Haitian midwife helping me. I had no way to communicate with her and therefore no way to obtain a history other than her age. By her fundal height and palpation, I knew she was either severely IUGR or very pre-term. I spent the few hours I was with her using my limited Creole, but so much body language and eye contact to express my emotion to her. Can you see that I care? Can you see my passion and desire to support you? Can you tell I care and that I will keep you safe, to the very best of my ability? You will be ok. You can do this.

Is it possible to say all of this with no words?

Glen was in an urgent section and Liz and I were with this young mom. She starts pushing. I check her and don't feel any cervix. Her baby is +2 station. We encourage her to keep doing what she's doing- nice deep breaths, relax, and push down when you get the urge in your bottom. She has moments of near hysteria, and from the sounds of it, she is asking God, “Why?!” We rub her arms and her back and try to let her know it's ok. We've made sure we have everything we might need- Pitocin, alcohol swab, cord clamp, instruments, ambu bag, and towel for baby. There is nothing else left at our disposal to get.

The hospital is a crowded, loud, bustling place tonight. It sounds like a circus from behind the drawn, filthy shower curtain that makes up our 'Labor and Delivery Suite.” I'm preoccupied with the 15 year old laboring mom and Glen comes in to tell us that he's done with his section. Mom is fine but baby had thick meconium and needed to be whisked off to peds. We chat for a couple minutes, he walks to the back (near another delivery bed), and I hear him ask if we just had a baby. Liz says no. Why? There is a blue, seemingly lifeless baby, wrapped in a blanket, laying there alone on the counter. Glen recognizes it as the baby from the c-section. WHAT IS HAPPENING?????? How much time has gone by?!?! 15 minutes? 20 minutes? I can't leave my patient, but they start resuscitation.
At some point, they rush baby to the peds unit.

The circus outside continues. Moaning and yelling and people who don't seem to be doing much are coming in and out. There are two other moms in labor and I'm going from curtain to curtain listening to heart tones, while keeping an eye on my pushing teenage mom.

I start to see head. The baby is nearly on the perineum at the peak of her push. But I'm also seeing something else. I hold up my two right-hand fingers and ask if I can check her again. She doesn't understand my words but gets what I'm asking and nods her head yes. I check and she's 6cm. It's her cervix I'm seeing. What the hell is going on? I seem to be getting a crash course in just about everything.

I listen to baby. Baby sounds great. I ask her to get on her hands and knees with her butt in the air and try to motion with my hands to flip over. She doesn't get it. I can't show her with my own body. I can't touch anything in this room. There's blood splatters and dirt and grime everywhere. I mimic being on my hands and knees (as I'm standing), and then help her turn over. Success.

Damn. I should have practiced my Creole.

Immanuel, Glen's translator, runs in full-speed yelling, “Tara, the DeLee! We need the DeLee!” I know he has no idea what this is, but he obviously knows that it is important when needed. I'm impressed with his urgency.

I have been carrying the DeLee on me all day. I knew it was just a matter of time until it would be needed. The midwives here have never seen one or heard of one before. I had planned on showing them at Friday's NRP class that we are teaching, as it's become quite apparent that neonatal resuscitation skill is nearly non-existent here. I hand it to him and he takes off as though he's a sprinter in the olympics. I know it must be bad and I wonder if Glen knows how to use one.

My mom is settled, baby is doing well, and delivery doesn't seem to be imminent, so I run over to the pediatric unit a couple minutes later. I find Glen using the DeLee like a pro, getting a fair amount of mec out. The baby is alive, and stable, and seemingly well. An IV has been started for antibiotics and glucose. We leave the baby in the care of the 1^st year pediatric resident that has helped us oh so much this past week. We have all become quite the team.

We get back to my laboring mom and the Haitian OB is checking her. He says we are no longer needed tonight. The girl is 8cm now. He says she's not contracting strong enough so he's going to start pitocin. WHAT? I tell him I just checked her an hour ago and she was 6cm. SHE HAS PROGRESSED. SHE DOESN'T NEED PITOCIN! My translator translates it and then translates back to me. “He is the obstetrician and you are the midwife.”

 

For the second time tonight I want to punch someone.

I wanted to yell at the absurdity of it all. Nothing made sense. Let's give a mom who is contracting well and making progress some pit just for the hell of it. Let's drop off a baby and leave it for dead on a counter, AS IF IT'S NOTHING. WHO DOES THAT???? WHY?????!

I am so angry. So sad for the situation here. But with the anger and the sadness, I also know that as bad as things are here, change and improvement has been made, exponentially. I have to hang on to that and not lose sight of that. Great things have been done. We have been told that 6 years ago people came to this hospital TO DIE. There were NO midwives, and the hospital cleaning ladies would do the deliveries. There was NO hope. And now, just a few years later, midwives have been trained and hired and there are at least SOME skilled attendants. There is SO much room for improvement, so many things that could be done better. But we cannot forget that strong and permanent change comes slow. We need to remember that regardless of how horrible some things may seem, care for mothers and babies in Haiti has improved and will slowly continue to improve.

So many of you have expressed interest and desire in volunteering with this organization. I cannot urge you enough to learn more about how you can help.

Midwives For Haiti students are trained by full-time in-country instructors. There is a continuous need for professionally trained midwives to give their time and money to help precept Haitian women in midwifery skills. They need our support and for us to share our knowledge and skill. Global health is our responsibility as human beings, and right here, right now, women and babies are dying unnecessarily.

I was told that here in Haiti you learn as much as you teach, and your life is never the same. 

True words.