Thursday, March 19, 2009

Re-Entry



Getting off the plane in Miami, I stopped to use the ladies room before I got in the passport line. I was so distracted by washing my hands in a clean sink, with soap AND paper towels! all together!! that I walked away and forgot my bag of duty-free rum. I was admitted back in the US through the passport line, and into baggage claim, before I remembered. Eventually, a customs staff person did retrieve it for me.

My heart did a flip when I passed a barber shop in the Miami terminal. I could get my hair washed, NOW! In the twinkling of an eye and with a painless zip of a plastic credit card, I receved a manicure (goodbye, dirty fingernials!!) and a shampoo and trim of my hair. The hairdresser was Cuban and spoke mainly Spanish, but I explained I had been "doing doctor work in the mountains in Haiti" and did not have many showers. Afterwards she said "Yeah, I seen the dirt come out in the sink!!" It was such a relief to be clean. Cleaner, anyway. I had brought more from Haiti than I planned--- Haitian road dust, all the way from Hinche.

I had not eaten since peanut-butter-and-bread-breakfast that morning at Fr. Jacques' rectory, so I needed food. I found the elevator up to the main concourse, and then a directory of the shops. I stood in front of the glossy black map of the airport terminal, and glanced down the list of restaurant and food choices. And I started to cry. I looked over my shoulder at the folks in the terminal, a little embarrassed. I wanted to explain"...Sorry, you see, I've been in Haiti. And they do not have this much...this much food. Or this much choice. The leap between worlds is overwhelming." No one was bothered by my tears, however, so I wiped my eyes and found some lunch. My salad & 1/2 sandwich was served in a clear plastic box, and it was very hard to toss it away afterward. I thought: Someone in Haiti would use that box! And they would. But getting it back to Hinche would be tough. A lot of the poverty is linked to lack of transportation and roads. I hope Haiti can get better roads. I hope so many things for Haiti.

I hope that the Midwives for Haiti program will survive and grow , to become an established school that produces more and more trained practitioners that can save lives and reduce those catstrophic mortality rates. I hope that the many good people in the US know that one of their closest neighbors, in their own hemisphere, is one of the absolute poorest nations on earth. I hope the Haitians keep on trying. There is despair and anger in Haiti, but there are so many who keep doing their best, each day, not only to survive, but to succeed. There are people in Hinche, tonight, reading under every street light, working to learn and improve their lives. Danise is at home in the rectory, writing a qualifying exam to ensure that only the best, brightest students will be admitted to this program that she now teaches. She emailed and asked for a desk, so apparently she doesn't plan to leave soon. There are student midwives in a classroom, five days a week, learning how to care for women and babies with respect and kindness and skill. And Danise told me that every day, they pray for us, their friends in the U.S. And then they sing.

Sunday, March 15, 2009

A Haitian Birth-day, or ,The 3 S's


Dear Nadene and Steve,

As I fly home to Dulles, I want to thank you (??!) for the casual encouragement you gave me that "it would be great if I could take some student's over to L&D and deliver a baby in Haiti" before my week was out. Well, my friends, I did that, and what an experience it was! I tend to believe God has a plan in all situations, so I guess I was meant to grasp in huge experiential detail what it's like to lack what I will now call the "3 S's ": STUFF, trained STAFF, and STABLE surroundings (like water and electricity...) The language barrier added a special thrill as well!

So, I chose the 2 students who had no birth experiences except their own. On Friday pm at 2, they dressed nicely in their pink scrubs and followed me over the the Salle Maternite. I saw no one in the delivery area, so I introduced myself to the nurse at the maternity desk as one of the "Saj Famn pou Ayiti" midwives from the US, and said I would be happy if I could help with a delivery. Of course this was thru the interpreter, so I hope that's what I said. But perhaps this meant to her " I am WonderWoman!!- Bring it ON!"...I don't know.

The nurse said that "OK they got somebody for you" and they got a laboring lady out of bed and walked her across the hall to the delivery area for me to examine. She got up on the table, I found some gloves, and examined her. Her cervix was 6 cm dilated and she was having strong contractions. She was having her second baby. While I was explaining this to my students, I was slightly disconcerted that more women were being brought in and helped onto more tables--- they kept coming!

The next one was 5 cm dilated, fully effaced, 1st baby. OK...but here comes #3. She's only 3 cm, but making lots of noise and obviously laboring actively. I was starting to feel confused...do they just hang around those tables until they deliver? What about the labor area? And the nurse who was leading the stampede was doing almost nothing to organize or help me! ( I later learned she was the only nurse for ALL the maternity patients.. including rooms full of postpartum women, including some receiving blood. Aha.) NO STAFF. So I found a doppler and started checking fetal heart rate on everybody-- let's see if all the babies are OK! They were. Praise God. Next, I figured, OK, They've already invented Group Prenatal Care: let's try Group Labor! So while lady #4 was climbing onto her table, I did a round of Blood Pressures; this was hard because it was so loud in there with all the laboring and hollering. As far as I could tell, nobody was over 140/90. The nurse asked did I want to give the one with the 140/90 BP some Aldomet? Well, No thanks, I said, but could we dip her urine? We could, and cup of urine and sticks were given to me which showed negative protein, so I decided to just watch her. I did manage to explain this to the students for minute, before lady #3 got off her table, pooped in the plastic bucket at the end of the table, and vomited on the floor...likely not 3 cm anymore!

I already understood that we had almost no help; there was nobody consistently nearby except me, my students, and our interpreter. But they were getting some labor and delivery experience, by golly!!
Now I was acutely aware of NO STUFF. NO gel for the doppler. NO Kleenex to wipe off the doppler. NO paper towels (or anything) handy to wipe up the floor. The water did work, so I did wash my hands as much as I could, but did not have towel to dry with. There were also flies around-- not quite #3, a "Stable situation". Each woman had brought some type of cloth from home to put under her on the plastic-covered table. Some had pieces of sheets, some had a night gown or a skirt spread out beneath them. Now, I understand that this is meant to get them through an entire birth, and goes home with them to be washed. The thought of a full bag of chux and a roll of paper towels ran through my mind and seemed like something I saw in another life!

Next, the infermiere brought me--WOW!--prenatal records on each of the laboring women! They had all visited the prenatal clinic at least once! Nobody had a hemoglobin under 10, and no one had tested positive for HIV, and they had all taken some vitamins at some point. No babies were coming breech, no twins; hey, It was my lucky day!

Danise came over about 3:30 and I felt like the cavalry came over the hill. I told her I was staying until Ronel came for me with the truck at 5pm, and she and the students all said they would stay with me and work. More trained STAFF! Hurray! Our lady on the third table had been getting more and more active labor...actually, at some points all the ladies were yelling and crying; quite the drama! Despite having locked away the medical boxes for the end of the week, I did have a small bag of STUFF that I'd carried with me "just in case", - I had some gloves, a gown, suture, Pitocin, Lidocaine, and syringes. I broke open a few of the diaper & onesies kits, and placed a new clean diaper under my patient who was ready to deliver. This move was greeted with disapproval by the Haitian staff, that I was using that nice clean cloth in this manner!

At this point I couldn't really communicate with anyone around me, because the birthing mom had her arms wrapped around the interpreter, screaming and pushing the baby out. God Bless her, Danise was there to help me, so we actually checked the baby's heart rate a few times, and she found me a few instruments that I can only hope were sterile; there were 2 clamps and a small scissors. Soon, we delivered a baby, a girl, and she cried right away. I had Camina stand by with a clean diaper (another one! I was tearing through the resources like a crazy person by Haitian standards) that we used to dry off the baby. We suctioned her, cut her cord, and wrapped her in a clean blanket. My heart was full of gratitude to the friends and moms who had donated all that STUFF. God bless them, too. We did active management of 3rd stage since I had the Pit, and bleeding was well controlled. Hooray for stuff and staff.

Next, the perineum needed a small repair. I was so happy that I could give this lady lidocaine for local anesthesia, as it is not routine there; I just happened to have some. HER lucky day! When I had the syringe loaded and went to inject the area for stitching, I realized I had no light but daylight. This lack, the third "S",I call STABLE Situation: the need for power & water. We angled the table so that afternoon sun gave me light. I asked for a stool to sit down on while I stitched...one was placed under my bottom, but oh dear, it was actually a seat not connected to the frame. So, with a loaded 10-cc syringe and and uncapped needle, I fell backward on my butt, onto the filthy floor...waving the syringe around and trying not to get hurt or puncture anyone! The girls caught me before I whacked my head or poked anyone,picked me up, got me on a chair. I went ahead and used the lidocaine as I felt it was still uncontaminated and that's what we had. I had the scissors and 1 small straight hemostat left, and Danise indicated that this is what I had to use to suture with. So nevermind, Steve, teaching the students the proper way to suture, with pickups! I did the repair with one hemostat and some Vicryl. The students were thrilled to observe hand ties and instrument ties, and were able to identify them as I did them!

In the end, we had caught a baby in Haiti, and I had to go home with my truck before the other ladies delivered. I was soaked in sweat and very tired! It was absolutely mind-boggling to me that this chaotic escapade, the craziest 3 hours in labor and delivery I ever spent, had actually been a big improvement over the usual birth scenario at this hospital. It's also astonishing that most of the women in Haiti do not get prenatal care, and do not deliver in any facility or with anyone with training, so that this story actually is a best-case scenario. My patient was attended by trained midwives, and had more care, more precautions against infection and hemorrhage, actual local anesthesia, and even some clean linen. Midwives for Haiti and the people supporting us can do so much better, if we keep going. I am grateful for the eye-opening adventure, and I am inspired to try to supply the 3 S's, and keep working for birth to be safer, and better, in Haiti.
Onward!

Friday, March 13, 2009

A New Baby is Born


During the weekend before the new Midwives for Haiti class started, there was a lot of concern over how things would work on Monday. Danise, the Haitian nurse-midwife who was hired to handle the main teaching, still had not received the key to our classroom from the hospital administrator. It was also a little uncertain how many students were accepted in the program, how many would show up, and whether we had enough books and school materials for them. We drove all over Hinche in the beat-up truck that is the Midwives for Haiti’s main transportation, with our driver, Ronel, locating supplies and equipment. There was medical equipment at the Whitney clinic, where a huge box of emergency OB drugs, supplies and a laptop were stored. There were notebooks, pens, gestational wheels, to pick up from the storage closet at the Bishop’s house. There were several huge boxes of books that came with Nadene on the plane, including the newly-printed version of “A Handbook for Midwives” in Creole. Nadene, Steve Eads, and I sat with Danise and talked about the week ahead and how to begin the teaching and introduction to the program. I had very little to add, being entirely new to this, but fascinated and excited just the same. So much energy and money and preparation was spent to “gestate” this “baby” the second class of Midwives for Haiti, and it was uncertain how the labor and delivery would unfold...

So, Monday morning we packed everything into Ronel’s truck, put on our nice skirts and makeup (except for Steve…for the record, he wore scrubs and no makeup!), and headed for the hospital. At the same time Kathie and Cindy and June headed for a big day of primary care at the Whitney Clinic. When we arrived at the hospital, the classroom was still locked, and Dr.Prince, the hospital administrator, was unreachable, out of town. Fortunately, the Ministry of Health building was open and had a room for us, with chairs, tables, and table cloths, all set up!! And gathered at the front of the building were 6 beautiful midwife students, with perfectly braidied hair, bright white blouses, dark skirts, and HUGE smiles. They were so excited it brought me to tears. Nadene and I were almost overwhelmed with excitement! We set up the table with places for each student, books, notebooks, pens, pencils, wheels, and tape measures. The students were invited in, and took places… Danise welcomed them in Creole, and then asked one of the students to open with a prayer , which she plans to do every day, as it is traditional here. Magdala, Pastor Jude’s wife, started the hymn “How Great Thou Art” , in Creole, and all the students joined in, loudly, and in harmony. With the acoustics echoing inside these cement walls, it was utterly angelic. Nadene and I both sang along (although we were so moved we were crying!) in English.

Danise then introduced the program, and asked each of us to introduce ourselves and speak about why we came here, and the background and philosophy of Midwives for Haiti. Dr.Eads told the students about how it took 2 years to train the first class, due to all the obstacles and changes that occurred during that time, but that it succeeded through great perseverance and commitment, on the part of all the volunteers, the students, and much support from friends in the US. He then explained that this second class is very important, because it will show that this process can be repeated, and become a truly viable established program . Nadene talked about saving the lives of mothers and babies in Haiti, and touched on how it is a primary value that the M4H midwives become famous for being highly skilled, and for their kindness and compassion. I spoke about my path from being a direct-entry home birth midwife, to having a large hospital practice, and how the work of a midwife in all settings, in all countries, is very hard work ,requires a love of mothers and babies, but has great rewards…”and I welcome you to this work.” Another new student arrived every 30 minutes through the morning, until there were 9, and 2 more expected for next Monday! We taught chapters 1 and 2 of the Handbook, and went to lunch in the truck, with HUGE rejoicing—the baby was not only out, it was robust and crying (or singing) loudly. Midwives for Haiti, Class #2, had begun.
video

Tuesday, March 10, 2009

Hinche-ing into the Project



Saturday March 7, 2009

We flew from PAP to Hinche by small airplane. The dry mountains spread out beneath us, then the river, and the one large reservoir and dam that supplies water and some power to Port au Prince. I only got nauseated at the end of the flight, with some bumps and jolts, but by then the spires of the Hinche cathedral were visible. We passed the airstrip once, circled around, and landed. Goats, donkeys, pigs, and horses graze on the airstrip when the planes are not landing.

Transportation in Hinche is bike, motorbike, donkey, horse, or truck. Our driver, Ronnel, drove us all around Hinche in a very old but sturdy pickup truck that has bench-seats welded onto the bed in back. We toured the hospital, the rectory, where they serve 3 meals a day for us, at 7, 12, and 7pm., and the Whitney clinic where the Nurse practitioners will see patients this week. The hospital tour was most dramatic...these people are making do with the most difficult conditions I’ve ever imagined. Family members mostly care for the patients. They bring their own sheets, linens, and food. The hospital care consists of a diagnosis, a plan, procedures as needed...they do have radiology, and a lab, and a pharmacy. But basically, each ward is a large room, without screens, and a concrete floor, and some beds. Water may or may not work in each sink, including in the delivery room. Each nurse checks on 10-20 patients, so the family does most of the care.

We checked into our motel, which is very, very nice for local standards. The huge courtyard is paved, landscaped and shaded with mango trees. The motel provides generator power from dark until 6 am, the rooms are screened with nice windows for a breeze, and each room has its own bathroom, although there is no hot water tank. There's security and a big iron gate that is locked all night. We settled in and I hung my bed-net, and filled my 5-gallon plastic sunshower, and set it out in the sun to warm up; this was a wonderful idea and I'm looking forward to a warm shower eventually! For even more luxury, we took a trip in the truck to th Ebenezer store, one of the largest shops (with actual glass doors!) and bought...ooooh! fairly cold beer!!!
Dinner at the rectory was Beans, Rice, goat stew, plaintains, bananas... thank GOD I love beans and rice!

The Hinche water supply is ok for washing, but not drinking. All drinking water is trucked in, or folks boil it before drinking. My water bottle, which I fill when we eat our 3 meals a day at Father Jacques’ rectory, has become the only thing I drink from. Hinche has no public electricity. Power is on only at night, and only in houses that have generators or large strings of car batteries. My little battery-operated booklight is another best friend. At night, candles and small fires, light some of the homes. Anywhere there is a streetlight, or any light on the street, there are small groups of people, reading, including adults with books and newspapers, and children with schoolbooks.
So we spent Saturday in travel and preparation mode, and on Sunday we'll go to Mass....then Monday, the real work begins. I hope I can do some good.






Welcome to Haiti!


Welcome to Haiti!
Friday, March 6, 2009

Miami, FL, connection to Port au Prince: Even in the airport terminal, it’s clear which gate is for Haiti. More people crowded and waiting, less luggage and more plastic bags, more body odor. It’s clear we are not flying to a tourist destination or a wealthy place. I sit down next to a Haitian –American lady and learn my first word in Creole: “Famn Saj “(midwife). I find Steve Eads, the OB-GYN from Richmond who serves as medical director, sitting on the floor talking on a cell phone to his wife one last time before leaving the country. Nadene Brunk, founder of Midwives for Haiti, and June, a peds RN and veteran of many trips, come along soon after. June functions as pharmacist and fills RX’s in the clinic. Cathy and Cindy, the 2 NP’s of this trip, are due on a later flight in the pm. We all have separate seats, as we booked separately, so don’t get to talk much on the flight.

We all meet up on the tarmac, happy to see 80 degree weather. The mountains surrounding Port au Prince are big and dry right now—reminding me of Las Vegas terrain. The airport scene is hectic but manageable but it’s great to be there with veterans: 2 different drivers were present to pick us up, so one is very disappointed. At the exit doors, over a barrier, a crowd of drivers are all shouting and haggling to get some work...welcome to Haiti! We have hundreds of pounds of baggage, but finally get it all into Nadar’s bus and start our ride through PAP to our guesthouse.

The Port au Prince streets look like a war zone, literally. Pot holes like bomb craters. A crazy jumble of compounds, schools, shops, street art, and street vendors. Goats, chickens, a few skinny dogs. Live chickens for sale. Cinderblocks and concrete, and lots of half-finished houses with only a curtain in the window; no screens, no glass. Finally, we rested at the Bensons’ guesthouse compound, a very simple but refreshing oasis that offers accommodations to missionary and medical missions. Shade, tile floors, a breeze, cold water, locked gates. Haitian art for sale in the front office. A great view from the roof of the surrounding city and mountains.

I get a good background story of the M4H program from Nadene and Steve. There’s discussion about the new class of midwives starting during this trip, that we’re coming to facilitate. On Steve’s laptop, we view the slide show of the graduation of the first class of midwives...So moving to see all these faces of new midwives, and to understand the work it took to train them. As it was the first class, and presented many organizational and logistical obstacles, it took 2 years to completely train 7 midwives. Now, with much more financial support and experience, and Haitian connections and alliances, the hope is that it may take 6-12 months. Just before dinner, we walk over to see “the Ravine”, a neighborhood just around the block from the guesthouse, and one of the most dense and impoverished sections of Port au Prince. This is an astounding experience. (see“Beans and Rice and Singing”)

Dinner is traditional Haitian food, served family-style; Beans, Rice, goat cooked with onions and carrots, fried plaintains, sweet potatos, salad, mango. A cold shower (hot water does not exist down here—but I have the SUNSHOWER along!!!!) ...exhaustion... and a deep night sleep.

Monday, March 9, 2009

Beans and Rice and Singing

The Ravine, outside Port au Prince, Haiti is a 40-acre ravine over a small river. Both sides of the steep ravine have been built up with concrete and cinder block and tin roofs, one on top of another, to house an estimated 70,000 people. There is no power and no clean water supply except what is carried in. My group of 7 health care providers stood at the edge of the Ravine on Friday night, my first night in Haiti, as dusk was falling. Adults and children filtered up and down the narrow winding path, to and from their homes, carrying water in jugs, small plastic bags of bread, rice, and charcoal. Candles flickered and charcoal fires were lit. As dusk fell and my brain and heart tried to grasp the reality of this many people subsisting in a space with this few resources, the smell of sewage mixed with the smell of beans and rice and smoke from cook fires. A church choir began singing a loud song of worship, a flute tune drifted up from a tiny concrete dwelling, and I had my first lesson on Haiti: the poverty in material things is profound; they survive on less "things" than I could have ever imagined. And their hearts are deeply spiritual. Most education is done through churches, and most events are begun and ended with prayer. And in the midst of this intense need, they sing.

Thursday, March 5, 2009

MORE STUFF and LOVE too

Thursday Evening, 3/5/09--MORE STUFF!

Well, okay. My 2 large, carefully packed-full bags turned into 3 large bags when, on my last day seeing patients in the office, my first patient gave me $200 "for whatever will help those moms and babies"...and then the Citranatal drug reps walked in with a trolley and 3 enormous cases of prenatal vitamins!! So, a third bag was borrowed and packed, with EVEN MORE STUFF, and I'll use some of the money to pay the $100 extra-bag fee that the airlines charge. I feel so grateful for the the donations of baby supplies, salvaged medical supplies, baby items new and used, and of course, finances. I've received financial support from my midwifery practice (thanks, Margie...), Goose Creek Friends Meeting, and several patients and friends. Many of the Loudoun Community Midwives staff and patients, friends and neighbors have donated diapers, onesies, blankets, pins, medicine, soap, sheets, and more. The staff at Loudoun Hospital's Birthing Inn saved me many pairs of unused gloves, gauze, suture, cord clamps, IV catheters, and much more. I even have a fair amount of healthy snack food I was advised to bring, for taking breaks with the students...apparently the students have gotten very familiar with granola bars thru the American midwives!---how appropriate. There is a lot of STUFF but I really know there is a lot of love and goodwill in the bags. I couldn't begin to make this trip without the support, love, and prayer that I know goes with me.

I think I feel ready, or as ready as one can. I started taking my anti-malaria doxycycline today, made rounds at the hospital for the last time in a while, and wrapped up admin. work at the office. Everyone has been so kind and supportive, and wishes me luck. I'm on call until morning, theoretically, but Margie's additional gift to me is that I can call her early to take over call, in time to get myself to the airport for a 6 am flight. Fortunately...no one is laboring so far, and I can tie up loose ends. I hope to learn how to better use my son Stephen's camera, and also hope to get a bit of time to be with my husband, Greg, until I can fall asleep and get a nap..before the 3:15 wakeup call. He and I've never spent this many days (9) apart and that will also be different. I'll miss him, and my whole life here.

After several huge challenges in 2006-08, including losing my mom to ovarian cancer, personal health and family crises, and business stresses, I decided to focus on a point of view that I consider my mom's legacy: Do More Good/ Have More Fun!
I hope this trip will do some of that.

Tuesday, March 3, 2009

Midwives For Haiti--Let's Go!

Here begins a blog documenting my trip to Haiti to work with and train rural midwives in Hinche, Haiti, with the non-profit Midwives for Haiti. The M4H concept is that Certified Nurse-Midwives and other medical staff from the US make regular trips to Haiti, with the goal to help reduce the maternal and infant mortality rate there. Training Haitian people in midwifery skills and providing supplies and support for their training is at the heart of the program.

We'll be working with a Haitian certified nurse-midwife who is employed by M4H, and will be helping to start a new class with about 15 students. I'm travelling in a group with Nadene, the founder of the program, Steve, an OB-GYN physician who is one of the medical directors, and several Nurse practitioners who will run clinics while we start the midwifery class. Our classes will be taught in a classroom at the local hospital, and they tell me I may do some work with students at the hospital as well.

I expect an experience that will be entirely different from my daily, cushy life in Northern Virginia. I anticipate sleeping in a mosquito net, frequent power shut-offs, cold water showers, and more poverty and health needs in the population than I've ever seen. I also imagine I may enriched in ways I do not yet know. I do know my heart leads me to care for mothers and babies, with a passion. I'm grateful to have a husband that supports and encourages that mission...and a lot of friends and family do too.... So you're all invited to travel with me, via this blog! Here we go!!