affectionately titled miracles and zombies

*on my foot:after performing minor surgery on myself on thursday afternoon i discovered a large piece of the original splinter was still deeply buried in my foot two weeks later, not that it's gone i am almost completely healed.  Hurricane Isaac came and went we saw some rain and wind and lost internet for 2 days,  all is well, thank you all for your concern.

Day 6-7 Thursday night – Friday morning: Miracles and Zombies

(written on Saturday)

Night shift started in a fairly straight forward way, as far as they go.  A few of the labor cubicles were occupied, one with a woman who clearly seemed to be in active labor.  Of course, entropy had undone most of the organizing that we had done 2 days before and had returned the room to it’s normal state of chaos in a measly 36 hours.  Carrie, the house manager for Midwives for Haiti, had decided to join us for the night shift, she had never seen a birth.  Lovely, the woman in active labor, told me she loved me and beseeched me to gently stroke her lower back, very uncharacteristic of a Haitian woman, she wanted a lot of labor support and would speak harshly to me if I stopped my attentions. I passed the task over to Carrie and went about preparing for the birth with the students.  Lovely’s blood pressure had spiked to dangerous levels (pre-eclampsia is endemic here for reasons mostly unknown) 162/112 and the scant urine that she was able to produce showed 4+ protein, so we began preparing medications to prevent her from seizing.  We had to ask the staff midwives to help us here because Maria and I would never manage a patient like this at home, she would be transferred to the care of an ObGyn at the hospital.  While the meds were being administered she began pushing and delivered a big, healthy baby boy about 10 minutes later. She asked Carrie and I to name him, I suggested Edward, Lovely decided that she liked Edwich better (at the time I thought that she had made the name up, riffing off my suggestion of Edward, but the next day I met a little boy named Edwich at the orphanage.)

An hour or so later as Maria was helping the students triage a young woman who came in complaining of vaginal bleeding for the past 3 days after “drinking misoprostol” in an attempt to induce abortion, one of the staff midwives came in to get a delivery kit, reporting that a woman had just given birth in the antepartum ward.  We asked if all was well and if she needed help.  She casually responded that things “could be worse” and yes, they could use some help.  I walked over with the translator, into the ward full of beds and onlookers to see the midwives waiting for the placenta to be delivered while a pale, limp, lifeless baby with her eyes open and staring in to space lay draped across her mother’s belly. I looked to the translator, “Is this baby dead? Can you ask them?” She backed away, scared, “I can’t, not out loud with the mother here.” The midwife turned to me, and with the translators help asked me to take the baby, as she was cutting the cord I saw the blood pulsing and knew that her heart was beating.  I grabbed the baby and ran her back to the labor and delivery room where all the resuscitation equipment is kept, she gasped once, shallowly in my arms as I ran.  I called for help as I ran in, we laid her tiny body on a gyn table, grabbed the resus kit and I started breathing for her.  There is no compressed oxygen in the hospital, no neonatal intensive care unit, no intubation, so the best that we can do is to inflate the baby’s lungs regularly.  Seconds after I started Maria put a stethoscope to er chest and reported that her heart rate was strong and steady and her pale body began to blush pink within the first few breaths, but her tone was not improving she was still completely limp.  5 minutes later, with no change, we knew that we couldn’t do this forever, but her heart was so strong and steady, we also couldn’t bear to stop.  Her eyes were glassy, glazed over and staring in to nothing, there was no light in her, she was just a husk of a human, we continued to try to call her into her body but for what?  Her mother was severly pre eclamptic, she was born premature and incredibly small with lots of medications on board.  The main one being to prevent seizures in the mother, which can have the side effect of causing lack of tone in the newborn until the baby’s body is able to process the medication.  I was hoping that was all that was happening.  20 minutes after we started, we stopped.  Her tone had not improved and she still lay limp and painfully small on the table, but against all odds, she was steadily breathing on her own.

I sat with her for the next hour waiting for her to stop breathing at any moment, singing to her, stroking her cheek, looking at her eyes: unblinking, half open, and like a broken baby dolls, going in two different directions and wondering if I had just made a terrible mistake.  Had I just “saved” the life of a brain damaged girl?  Had I just saddled her and her family with a life of pain and suffering when I could have just peacefully let her die?  How long had she been laying there on her mother’s belly, unbreathing, and in that time had her brain been irreparably damaged?  Why ad the staff midwives not reacted faster?  Did they know that this was bound to happen so why exert all that effort and false hope when this was the inevitable outcome?  What I wouldn’t have given for a NICU, a neonatologist, nurses, brain cooling, god even just some oxygen would have been a god send at that point. But maybe all that thinking is too American, maybe if a baby isn’t born screaming here they won’t make it anyway, whether it’s within hours, days or years, it certainly seems that you need to be strong to make it here, and my American solutions are unlikely to solve Haiti’s “problems”.  I felt so small, helpless and unqualified for everything I was trying to do right there.

Once she’d been stable for about an hour, Maria and I decided that we needed to go check in with her mom and ket he rkow what was happening.  We decided to bring the baby with us, all 3+ lbs of her, and while we wanted to keep an eye on her we agreed that one of us could stay with her if her mm wanted to keep her by her side. My hopes weren’t high for this based upon how poorly women seem to bond even with their healthy children. We explained to her mom and her two female relatives who were with her, what was happening and htat we were hopeful but unsure if the baby girl would survive the night.  I will say she didn’t look very good.  And when we gave mom her options, she waved us away and covered her face with her outstretched arm. 

I kept vigil over our little girl in the L&D room while Maria went to lay down on a mat on the floor of the storage room.  Slowly but surely over the proceeding hours she began moving her legs and extending her arms.  She wrapped her tiny fingers around one of mine, her hand only taking up the space from the first to second joint of my index finger.  I put the erythromycin ointment in her eyes, and she squeezed them tight against the assault, I took a picture of her and winced and wrinkled her forehead against the flash.  I will say that I shed some tears over all of this and decided that it was time to bring her back to her mother, she was either gong to survive the night or she wasn’t, but there was nothing more that I could do for her.  I laid her next to her sleeping mother who I was able to briefly rouse and explained to her support women that I was hopeful and that the baby would continue to be very sleepy but I hoped that as the medicine continued to wear off that she would continue to improve.  I returned an hour or so later to check on her and the women were hand expressing colostrum into a spoon and spoon feeding the baby. After showing them a way to get more, I encouraged them to continue and applauded their efforts.  A couple of hours later and the baby wasn’t looking as good.  She looked to be working a little bit hard to breathe and her beautiful blush of color was returning to it’s paler state.  Maria suggested that we transfer her to Zamni Lasante, the Parner’s in Health hospital 1 hour down the road, where they were better equipped to take care of her.  It was 4 am at this point and we found out that it would be at least 8 until we could talk with the medical director who would give us permission to take her in the ambulance.  We left her at her mother’s side hoping for a miracle.

Over the next few hours we had a few deliveries of healthy babies and while I slept Maria managed the delivery of a still born, premature baby and the placenta of a woman who came in with a tiny, dead fetus in a box.  This place is not for the faint of heart and I every night that I work here I understand a little better why the staff midwives seem so distant and detached.  I could never handle to emotional turmoil of this place on a daily basis. 

We checked in on our little girl as we were leaving the hospital around 730, planning on setting up the transfer of care, and she looked amazing! Her eyes were centered, her color was great, she was breathing normally, she hadn’t nursed yet but she was taking the expressed colostrum well.  On the walk home we decided to call her Miracle, Mirak in Kreyole.

We got back to the orpahange with just enough time to wash the detritus of the night off of our skin, grab some food and coffee and hope on the motorcycle taxis to a matron training on the other side of the river.  This training program was started by one of the Midwives for Haiti midwives and instructor, Jeanette, a true shining star down here.  This is the first year of this 20 week program that meets every Friday from 9-11am.  It’s goal is basic training for the local, village traditional birth attendants (TBAs) or matrons as they are called here.  In Haiti many of these men and women are local healers and some are witch doctors.  Voodoo was born in Haiti and while most Haitians claim Christianity as their religion, Voodoo still thrives in the underground of village life.  One of the matrons in the class was in fact a Manbo or female witch doctor, she rose to pronouce to the class her joy at knowing now that many things she had previously attributed to evil spirits or possession by a zombie, she now knows have medical causes.  Eclampsia (the seizures that can follow a diagnosis of pre-eclampsia) is commonly thought in the villages here to be the possession of the woman by zombie spirits.  The violent shaking and unresponsiveness associated with these seizures could certainly make one think of walking dead.

It was a fabulous class with lots of singing, songs about proper hand washing and when to transport women to the hospital for care.  It reminded me so much of my time in Sierra Leone a few years ago, training TBAs in the villages there.  I stood up, and with the help of Gladius our translator, told them how happy I was to be there and how glad I was to see how much they were learning all in the name of helping their people, my exhaustion bringing some tears to my eyes.

Once we got home he remainder of the day was spent resting and watching hurricane Isaac descend upon the central plateau.  Brother Bill treated us to a big screen movie out on the porch where we sipped Haitian rum and nibbled dried mango, it all felt positively luxurious.  The night brought high winds and it has been raining for 24 hours now, it’s a snow day at boarding school as Brother Mike says.  The kids all either wrapped up in blankets against the unseasonable chill in the air, or running through the yard naked, using the weather as a shower. 

Sunday addendum:

We walked up to the hospital yesterday afternoon once the deluge finally stopped.  Mirak passed away at 6am.  The family not wanting the mother to know that her daughter had passed until she was back at home had told her that the baby had been taken to Zamni Lasante for more extensive care.

We bought beer and cookies on the way home, danced ourselves sweaty in the dark hallway of the girls dorm and generally tried to let the day and the baby go.  “Frankly I’m relieved,” Brother Mike said and while I know that he’s right and can’t help but wish it had all turned out differently, that I had been able to truly save her life rather then just prolong her suffering.  At least we gave her mother the opportunity to lay with her for 24 hours, I think that’s a good thing.