another note from the tropics

Day 4-5 night shift: l'opital St Terese

i know that every year that i have come here I am initially apalled at how disorganized the labor and delivery ward is, so this rant will be nothing new.  I also will say that there have been signiifcant improvements here since our first year.  The power is now on 24 hours per day, no longer a generator, there is now running water in the hospital (not potable of course but you can use it to wash and clean) and there is a stand with bottled water on the L&D as well so we can get drinking water for the women in labor if they don't have their own. There is now a storage closet that is fairly clean and well organized that can be locked, also the new medical director sounds great, he is at least not a power grabbing misogynist like the last one so the rest of the hospital no longer is free to raid our supplies, the women in labor can have a family member in the delivery room with them if they choose, we can use male interpretars in the hospital (we would prefer women of course but the status of women in Haiti means that it is rare to find an educated bilingual women, there is only one with the program right now, Shirley, she works the nigt shift with us), we are now able to have IV supplies and fluids on hand menaing that families no longer need to find these for themselves in the middle of the night while their family member hemorrhages, so there have been significant improvements all around.  They have even precariously hung a few paintings on the walls of the delivery cubicles.  All that being said, the lack of organization and general cleanliness blows my mind.  When I walk into a birth, especially when i am in an unfamiliar environment or assisting a midwife i don't normally work with, I take a few minutes to figure out where everything is, especially the emergency equipment.  I am particularly careful to do this when i start at shift at St Terese because it is often so chaotic and things are never where we left them the day before, this is how i was taught, to minimize the stress and maxamize the efficiency.  I know that whenever we come here we emphasize these things but it seems to no avail, the staff midwives don't keep things tidy and organized so the students aren't getting a consistent message.  The result, even the most straightforward deliveries seem chaotic and rushed, and needed supplies are not on hand.  Supplies also get over loooked, a box of medication i found in my inital 5 minute perusal was later needed and all the midwives were shocked when i pulled it out of the cupboard, they didn't even know it was there.  Unfortunately the whole lot expires at the end of the month and will therefore be thrown away.  The Haitian people whom i have met and i encounter walking around are very neat and tidy in their appearance but as i have said before they do not hesitate to throw garbage in the street, or the empty lot next door, or in their own yard for that matter so i am not sure why I am surprised that the hospital is no different, I guess I just wish it was but I am not sure how to teach this. 

The shift started slowly, no one in active labor, Maria and I cleaned, organized, threw out and wiped down with our students helping out and the staff midwives looking on.  The early morning brought 3 healthy babies.  The first was born swiftly and peacefully in the antepartum ward as a young, first time mother was trying to sleep.  The speed of her birth meant that she wasn't even afforded the minimal privacy of a small cubicle with a shower curtain as a door. She birthed with the eyes of the 11 other women in the room and their assorted family memebers who were asleep on the floor beside their beds looking on.  This little boy even with his lusty cry and rapid, seemingly painless entrance, wasn't enough to inspire a smile from his mother.  This is one of the hardest parts of attending births here, the women do not express joy at the birth of their children, on the contrary, they appear despondant and exhausted and often refuse to even look at their babies.  I had always naively assumed, before coming here, that tears of joy upon hearing your baby's first cry was a universal human experience, but i now realize it is a cultural one.  The taped up cardboard box, which served as a make shift coffin, that sat on the counter top next to the baby scale all night, was a painful reminder of the danger of getting too attached to your baby here.

Our 2nd and 3rd births of the shift were both healthy baby girls, both with meconium stained fluid (we got to teach the students about suctioning a baby with a delee which was good for them to see) and both to first time mothers.  They both were also a bit of an exercise in chaos as our students scrambled to get their supplies together, looking to us and even our interpretor to help them.  Leading to our big teaching point of the night, preparedness.  How do you teach critical thinking skills to adults who have only ever learned to follow orders? We are teaching a class next week and i think our topics will be cleanliness and what i am calling "thinking like a midwife": being prepared for all eventualities, having the tools you need ready and available and thinking ahead.  When these things are in place you are left with the space and confidence to calmly be with women.

we are on for another night shift tonight with the same students so more to come

take good care and be well

ami

*thank you all who expressed concern about my foot, i have started antibiotcs for it and it seems to be improving.  also there is a hurricane scheduled to hit Haiti this weekend which some of you have written to me about but from what i understand we up here on the plateau do not have to worry as the mountains break up the storms so we should just see wind and rain.  thanks again for all the love and support