a day late

Wednesday 8/29

The streets of Hinche are teeming with life.  There are motorcycle taxis (mototaxis) everywhere you look, people walking, some with impossibly large loads on their heads others pushing wheelbarrows laden with bananas or charcoal.  There are also SUVs, oxen teams hauling carts, overburdened donkeys and bony horses often carrying women or small children in addition to their goods.  There are no traffic signs or speed limits (the quality of the road takes care of this last one) horns are beeping constantly, used for warning, displeasure or greetings alike.  The airstrip across from the hospital hasn’t seen as much use in recent years, now that the road from Port Au Prince has improved, as a result it is now fully given over to grazing and children, horses, goats and pigs wander among kids playing soccer and skinny little dogs. The sides of the streets are littered with small shops and stands, selling gum, small packets of crackers and sweets.  There are also lottery stands called "banks" everywhere you look and people sitting with large bowls selling avocados and sugar cane stalks.  Cars and motorcycles are repaired on the street and tables are made.  In Haiti life is lived on the street.  It is a communal society and to be alone is to be unloved. It is an amazing thing but it can also be exhausting and loud.

The internet has continued to be down which is why my emails have been so sporadic.  Monday, which happened to be my birthday, was a good day.  We went on the mobile clinic with Magdala and Filomen, two of our dear friends here who we met our first year.  Mobile clinic is one of the greatest achievements of this program in my opinion.  They go to 16 different sites every month, some hours away by jeep, and see upwards of 400 rural women for regular prenatal care, care that these women would never have access to if it weren’t for Midwives for Haiti.  Education is a big part of every clinic.  They have a class about nutrition or breastfeeding or some other topic and let them know the warning signs of preeclampsia and other dangers of pregnancy at every meeting.  The women not only have their vital signs taken and their baby’s listened to and measured, but they are also given prenatal vitamins, iron and antacids and Tylenol if needed.  They test every new patient, on site, for HIV, malaria, syphillus, anemia and gonorrhea and get her further care and treatment as needed.  Everyone we saw there was healthy except for one woman who I am fairly certain had choleostasis but there is no where to get her the further testing that she would need to confirm it and nothing to do to help her other then hope that her baby survives until she is term and get her delivered, maddening to be sure and again it makes me appreciate that as frustrating as the health care system is in the US, at least I can get my patients the tests and care that they need.

In the afternoon we visited Magdala’s family. She and her husband have taken in 12 orphans in the last couple of years and are looking to raise funds to build an orphanage, a school and a birth center on their lovely piece of land.  Since I last visited their home two years ago they have finished construction on their house and planted beautiful gardens full of vegetables.  We met their children and had a lovely rainy afternoon on the porch singing songs and telling stories.  Once we got back to the orphanage a wonderful fritae was waiting for us (a Haitian meal consisting of a variety of delicious fried foods, including homemade potato chips and fried plaintains) Maria made me a chocolate cake and I even got to blow out a digital birthday candle on Dina’s iPhone, we then went over to the girls dorm for a dance party. I will tell you that you have not lived until you have had 60 haitian girls sing you happy birthday in Kreyole before they jump all over you and smother you with hugs and kisses. It was definitely one of my best birthdays so far and one of the most fun I have had dancing in a long while, they even taught me some new moves.

Yesterday (Tuesday) we spent the morning in class with the midwifery students.  Maria and I did a review with them.  I discussed resuscitation, highlighting our story from last week, we discussed ethics and responsabilities as well as technique.  We talked extensively about the importance of being organized and prepared and did some exercises with them to this end.  We were originally going to go the hospital last night and Thursday night but it was moved to tonight and tomorrow night, so yesterday afternoon instead of resting in preparation for the night shift, we went to the waterfall that is about an hour away and had a lovely swim, it was fantastic!

Maria went to Port Au Prince at 4 this morning with Jeanette to hopefully help her get a visa so that she can come to the national midwifery conference in September in California. I went to the Azile and fed some of the babies while the sister and the lay women bleached their room down and cleaned their mattresses.  I was singing to kids out on the porch, looking into 20 big brown eyes.  Kids sick with malnutrition, here to get fed and healthy until they can return home to be with their families.  It is simultaneously a very difficult place to be and incredibly rewarding.  I always find myself apologizing when I leave there that I haven’t stayed longer or helped more, held just one more child, changed just one more diaper, but often here it never feels like enough.

We are back at the hospital tonight and it feels like there is so much left to do before we leave on Saturday morning.

Thursday 8/30 6:30am

I am just getting in from an overnight at the hospital.  It was pretty quiet, as far as they go.  We had two births in rapid succession right after we arrived and then nothing until early this morning.  Three healthy babies were born in the night and one was born very premature and only lived for a short while after a very difficult birth. I feel like i am seeing more premies this year then in years past.  I felt historically like they were either still born or they came out healthy and robust, this middle ground is so much more trying on everyone.  These are babies that would do great in the US, they are often somewhere between 30-34 weeks and just need some pretty basic support like oxygen and some help with feeding until they are strong enough, but they just don't have that available here.  I am hoping that this in crease is due to Midwives for Haiti educating the women about preeclampsia signs and symptoms and getting them in to the hospital.  I their symptoms are sever enough they will induce her labor regardless of how far along she is, saving her life is more important.  All of the premies I have seen this year have been children of induced preeclamptic moms, so in a weird way this perceived rise may be a good thing.  There was a woman in the postpartum ward last night, she had her baby boy yesterday afternoon, around 4pm.  He was very small, she didn't know her dates but he looked to be around 30-32 weeks.  She was very worried about him because of the 5 children she has birthed, only one other is alive and this little guy hadn't cried or eaten since he was born. I tried to help her express colostrum but we couldn't get any, although she said that she breastfed her other children, there was no formula at the hospital and no where to get it in the middle of the night so all we could give the little guy was some glucose water.  The mom asked us to put him in an incubator, which of course isn't available and the midwife said they are hoping that the family will take the baby to Cange today to the Zamni Lasante hospital where they are more equipped to care for him.  He was resting peacefully next to his mother as we left this morning, so hopefully he makes it.  

Today will be a day to rest and then we return to the hospital for our last shift tonight. There are many things that I miss about Haiti when I am not here but the fetid .smell of the hospital on a hot, humid, and still summer night is not one of them. :-)

take good care