I have been home now for more than 10 days and I am finally sitting down to write this last (?) post. My last weeks in Haiti were filled with births, deepening personal connections and a bit of a look at the world outside the birth centre. Sitting in my bedroom of my condo, with Leeum visiting, its almost as if I was never in Haiti. Life in Vancouver just takes over again and I find myself wondering how to integrate the experiences of the last month.
A few of my last memories include
Camp Pinchenat
Myself and a couple other midwives finally got a chance to go to Camp Pinchenat, the local camp for displaced people (those left homeless after the earthquake). Unlike the massive camps my friend Maxo works at in Port-au-Prince, this one had only about 5000 people still living in it. The community organizer and local artist, Charlotte, took us under her wing and quickly delivered us to a woman who had had her baby 3 days earlier, under the watchful eye of a local security guard. She and the baby were doing really well, despite living in a small section of an oppressively hot, green army tent. It was her 3rd baby and apparently she had gone to the hospital the day after the birth for a check up, where she was given antibiotics to prevent infection due to her tenuous living situation. The most interesting thing we found was her basket of pills. She had seemingly kept all the pills anyone had ever given her, including some expired antibiotics she had taken in pregnancy and alot of methergine (an anti-hemorrhagic drug used usually only in cases of post partum hemorrhage). We explained the danger in having the methergine around and Charlotte quickly took it all away. Later, walking in the streets of both Jacmel and Port au Prince, I saw plenty of pills for sale on the side of the street and realized I had no idea how common it may be to have pills on hand 'just in case'. The saddest story at the camp was the young woman of about 15 or 16 yrs old who came to us looking for help. She had apparently been the victim of a gang rape a few days before and was disoriented and incoherent. Charlotte translated and explained she had already been in touch with Amnesty International, The Red Cross, the local police, MSF and anyone else she could think of about the situation and she had found the girl a place to stay outside of the camp, but she kept returning to the camp in this state. It was heartbreaking not to be able to offer her anything.
1200g baby
My last day of pediatric clinic, I met the smallest living baby I had ever seen. She was 5 days old and had been born at home at about 7 months gestation with a local midwife. Her young mother brought her in for a check up, appearing to be totally happy with the way things had been going. She weighed 1200g and slept through our whole 1.5 hour appointment. Her mother said she had been feeding, but it was hard to believe since she was so lethargic and small. At 7 months babies have often not developed their suck reflex yet and so can have great difficulty feeding. I taught her kangaroo care, which originated in South Africa and involves wearing preterm babies, skin to skin on the mother (or other relatives chests) around the clock. Preterm babies have a hard time maintaining their own body temperature and kangaroo care mimics being back in the womb as much as possible. Her mama also was given a breast pump and taught how to syringe feed the pumped breastmilk. She took 1.5 ounces during the visit and should hopefully be getting that every 2 hours in order to grow. It was only at the end of the visit, so focused on the baby, that I took the mama's BP - which inevitably was high, likely why she had the baby early in the first place. And unlike in Canada, where we order bloodwork, send women to see OBs and follow them very closely for postpartum complications related to high BPs, I couldn't do anything. All I could do was send her home with some homoepathics and herbs, along with the danger signs of seizures (the ultimate risk with high BP) and hope that her body would just settle out on its own. I didn't see her or the baby again before I left, but the other midwives were committed to following up with her and the baby.
15 seconds
Until this last entry, I don't think I have written much about the impact of the 15 second earthquake on particular friends lives. I met a lot of students who had been studying at the university in Port au Prince when it happened. As you may have heard, whole faculties were lost when some of the buildings collapsed. The students I met described where there were, some in class, some on their way to class, some playing basketball. They describe walking through the city, picking up their classmates and taking them to the hospitals, some so covered in blood they didn't know if they were alive or dead. Body parts just lying around in random places, or being taken by dogs. One got a cellphone call from her mother, as she lay crushed under her building at work, but by the time she got there, her mother had already died. One had been playing basketball and was left, for 3 days, in the same shorts and t-shirt and eventually walked part way back to Jacmel to be with his family. He was just about to graduate, planning to defend his thesis the next day (Jan 13th) and yet the earthquake killed his thesis advisor, his thesis itself and he is just now returning to re-writing it, under the guidance of a new advisor. One of my artist friends took Bonnie and I walking early one morning, and showed us the house he used to live in. It is still standing, no structural damage and in fact housing 2 Canadian agronomist, but he refuses to live in it. Its concrete and he prefers the tent he has on his aunt's property. Most of his art since the earthquake, has focused on the 'catastrophe' (as many people refer to it as), including making art from pieces of rubble and teaching workshops to kids to make art of all that is left. One of the translators took me to her tent, which is on the side of the road across from the house she used to share with her son, her aunt and various other relatives. She had had a larger tent for her and her son, but a few nights earlier, while at a birth with us at the birth centre, her tent had been destroyed by some neighbors due to a conflict someone had with her aunt. She and her son were now living in a tiny 2 person tent. She also introduced me that evening to a couple of the children of the woman I wrote about with the massive post partum hemorrhage. They lived on her street, cared for by various neighbours. When she introduced me to them, they were polite, giving me kisses on the cheek, but also staring blankly at me when she explained who I was and that I had helped their mother have another baby. Finally, on a bit of a more cheerful note, I was invited to visit another of the staff from the birth centres house. She had made delicious breadfruit and chicken balls on a coal burner with her mother for me and all her family was around to meet 'le blanc'. Her younger siblings were so fascinated by me and my skin colour, that the youngest blurted out, after having played with my hair and sat on my lap,'I know! It was Jesus that made you white'. Apparently the next morning she had piles of questions for my friend, where does she live? does she have parents? does she sleep? how does she sleep? where does she sleep?
And so, my last entry, like me, is a little scattered. Thanks again to all of you who supported me to be able to do this work. Your donations, your emails, yours text messages, your responses to the blog all made it possible. I will likely go back to Haiti, I feel it deep in my bones.
Over and out, from Vancouver.
Friday, July 9, 2010
Monday, June 21, 2010
Eating mangos and sharing birth stories
So, I guess I haven't figured out the picture upload thing yet, or else the internet here is just too slow. Sorry about that. You will have to wait until I try again, or I get home (whichever comes first).
Just wanted to write a little about my morning yesterday. It started about a week ago, when 2 traditional midwives (sometimes known as traditional birth attendants, but they didn't refer to themselves that way, so I won't either) transfered their cousin in to the clinic in labour. We spent the birth sharing ideas and ways of practicing in broken French/Creole. Since the translator wasn't able to be there that night, it was whatever I was able to communicate/understand that ended up being exchanged (this has happened more often lately, in part due to the difficulty of a translator getting to the clinic in the middle of the night - there is no transportation available from our end as we only have one scooter for whole clinic and there is no public transport available after about 10pm).
In any case, it was an 70 year old experienced midwife with her 20 year old grand daughter who has been apprenticing with her for a few years. They brought their cousin in, we found out today, due to 'mystical problems'. They believed she wasn't able to deliver because of some type of spiritual issue. And yet when she got to the clinic, she was almost complete, and really only took a couple of hours (normal for a first time mama) to push out her baby.
As all who know my interest in all aspects of midwifery, registered and unregistered/traditional, I was drawn to these women. We essentially managed the labour together, all the while confirming or challenging each other on management type issues. One that was hard for me, was the plugging of the butt. They do this, they said, because like so many women the world over, they are afraid to poo during birth. Mechanically as the baby passes down the birth canal, it pushes past the rectum, thereby pushing out anything there, so its not really something that can be avoided. It is so common for us to wipe up, change gloves and carry on, we barely think about it anymore. The young apprentice was plugging her cousin's butt to help prevent the sensation, but then when it didn't stop the inevitable, she would, without changing gloves, continue to monitor the progress of the delivery of the head. It was a teachable moment, but hard to do in my broken Creole/French. We gifted them bags of gloves when they left the next morning, healthy mama and baby on the back of a motorcyle, midwives walking back to their community, about 1 hour away.
This morning we went to visit them at their 'birth centre'. It was a 30 minute crazy uphill motorcycle ride, followed by a 30 walk up hill. We left at 630am to avoid the heat and soon we sitting around in front of the little house that is their birth centre, being introduced to the 3 mamas and babies who were there. One had been born 5 days before, one 10 days ago and another was 3 months old. The older babies were there for 'mystical' reasons, the younger one just hadn't gone home yet following his birth. The 3 month old apparently comes and goes, because he is 'possessed'. These midwives are known for being able to see things, as well as catch babies. They have 2 temples that they pray at to assist in ridding these babies of their possessive spirits. This again, is the best interpretation I can give based on the translation we had. We spent the morning holding the babies and asking questions/exchanging information about birth, local plants and remedies and meeting all their extended family members (the young apprentice is one of 11 children!). We brought gifts of baby blankets and more gloves. They fed us lunch and loaded us up with mangoes, coconuts, breadfruit and corn for our trip back to the city. The elder midwife, Toune, kept telling us how happy she was to have had us visit. Adrianne, the young apprentice is eager to come and learn with us at the clinic once a more formalized educational program is available and was so proud to introduce us to anyone and everyone who came by.
On the way back down the mountain, we stopped in at the cousin's house. She had a uterine infection (likely due to the issues described earlier) and had been in the clinic on Friday for antibiotics. She was doing much, much better yesterday and was planning to come and visit us today for a check up anyways.
This collaboration between midwives, traditional and western, was one of the nicest interactions/transfer I have experienced in working as a midwife here, in Canada or Zambia. Yes, we all practice differently. Yes, there are cultural beliefs and practices that are beneficial and/or inconsequential and/or harmful across the board. And yet, as always, there are universal concepts re birth that can be shared and styles and practices that can be expanded upon. I hope that this transfer and exchange will create an opportunity for these women to continue to connect with us at the clinic.
I dream that this type of transfer and mutual respect will become more and more possible between homebirth midwives and hospital staff both here and in Canada. Our clinic is considered a hospital by the women who come to birth with us, but for us to transfer to the 'real' hospital, we too go, as I feel these midwives may have come to us, with some trepidation and fear. We have our own practices/beliefs/styles which differ dramatically from the local and Medecins Sans Frontier (MSF/Doctors Without Borders) doctors/obstetricians who run the maternity and pediatric wards at Hospital St Michele. Each time I have transfered to the hospital here, I strive to explain why I am there, what has happened to lead to me to bring this patient in and then I have to let go, in order to appreciate the expertise I have come to seek. My last transfer to the local hospital was of a very sick baby 48 hours old, with a very slow heart rate, temperature 40 degrees C (that is > 102 F), lethargic and a greyish tinge to his skin. I just went to see him 36 hours later, and already, after a few doses of antibiotics IV, he is looking so much better. All the nurses I met along the way were friendly and took into account the history I had for the mama and baby. Other transfers have not been so smooth. One thing that is reassuring, every time we have transfered the women and the babies have come back to the clinic to let us know how they are, tell us their birth stories and receive follow up care. To me this means that despite and/or because of the decision to transfer, they trust us and appreciate the care we offered all the way up until and during the transfer process.
Here's to greater interdisciplinary collaboration, from traditional midwives practicing in small, remote village situations, to homebirth midwives or registered midwives or nurse midwives or family doctors doing maternity, to obstetricians and pediatricians practicing at hospitals, both those small, underfunded, undersupplied institutions like the one here in Jacmel, to those larger, well equipped ones in cities throughout the world.
Just wanted to write a little about my morning yesterday. It started about a week ago, when 2 traditional midwives (sometimes known as traditional birth attendants, but they didn't refer to themselves that way, so I won't either) transfered their cousin in to the clinic in labour. We spent the birth sharing ideas and ways of practicing in broken French/Creole. Since the translator wasn't able to be there that night, it was whatever I was able to communicate/understand that ended up being exchanged (this has happened more often lately, in part due to the difficulty of a translator getting to the clinic in the middle of the night - there is no transportation available from our end as we only have one scooter for whole clinic and there is no public transport available after about 10pm).
In any case, it was an 70 year old experienced midwife with her 20 year old grand daughter who has been apprenticing with her for a few years. They brought their cousin in, we found out today, due to 'mystical problems'. They believed she wasn't able to deliver because of some type of spiritual issue. And yet when she got to the clinic, she was almost complete, and really only took a couple of hours (normal for a first time mama) to push out her baby.
As all who know my interest in all aspects of midwifery, registered and unregistered/traditional, I was drawn to these women. We essentially managed the labour together, all the while confirming or challenging each other on management type issues. One that was hard for me, was the plugging of the butt. They do this, they said, because like so many women the world over, they are afraid to poo during birth. Mechanically as the baby passes down the birth canal, it pushes past the rectum, thereby pushing out anything there, so its not really something that can be avoided. It is so common for us to wipe up, change gloves and carry on, we barely think about it anymore. The young apprentice was plugging her cousin's butt to help prevent the sensation, but then when it didn't stop the inevitable, she would, without changing gloves, continue to monitor the progress of the delivery of the head. It was a teachable moment, but hard to do in my broken Creole/French. We gifted them bags of gloves when they left the next morning, healthy mama and baby on the back of a motorcyle, midwives walking back to their community, about 1 hour away.
This morning we went to visit them at their 'birth centre'. It was a 30 minute crazy uphill motorcycle ride, followed by a 30 walk up hill. We left at 630am to avoid the heat and soon we sitting around in front of the little house that is their birth centre, being introduced to the 3 mamas and babies who were there. One had been born 5 days before, one 10 days ago and another was 3 months old. The older babies were there for 'mystical' reasons, the younger one just hadn't gone home yet following his birth. The 3 month old apparently comes and goes, because he is 'possessed'. These midwives are known for being able to see things, as well as catch babies. They have 2 temples that they pray at to assist in ridding these babies of their possessive spirits. This again, is the best interpretation I can give based on the translation we had. We spent the morning holding the babies and asking questions/exchanging information about birth, local plants and remedies and meeting all their extended family members (the young apprentice is one of 11 children!). We brought gifts of baby blankets and more gloves. They fed us lunch and loaded us up with mangoes, coconuts, breadfruit and corn for our trip back to the city. The elder midwife, Toune, kept telling us how happy she was to have had us visit. Adrianne, the young apprentice is eager to come and learn with us at the clinic once a more formalized educational program is available and was so proud to introduce us to anyone and everyone who came by.
On the way back down the mountain, we stopped in at the cousin's house. She had a uterine infection (likely due to the issues described earlier) and had been in the clinic on Friday for antibiotics. She was doing much, much better yesterday and was planning to come and visit us today for a check up anyways.
This collaboration between midwives, traditional and western, was one of the nicest interactions/transfer I have experienced in working as a midwife here, in Canada or Zambia. Yes, we all practice differently. Yes, there are cultural beliefs and practices that are beneficial and/or inconsequential and/or harmful across the board. And yet, as always, there are universal concepts re birth that can be shared and styles and practices that can be expanded upon. I hope that this transfer and exchange will create an opportunity for these women to continue to connect with us at the clinic.
I dream that this type of transfer and mutual respect will become more and more possible between homebirth midwives and hospital staff both here and in Canada. Our clinic is considered a hospital by the women who come to birth with us, but for us to transfer to the 'real' hospital, we too go, as I feel these midwives may have come to us, with some trepidation and fear. We have our own practices/beliefs/styles which differ dramatically from the local and Medecins Sans Frontier (MSF/Doctors Without Borders) doctors/obstetricians who run the maternity and pediatric wards at Hospital St Michele. Each time I have transfered to the hospital here, I strive to explain why I am there, what has happened to lead to me to bring this patient in and then I have to let go, in order to appreciate the expertise I have come to seek. My last transfer to the local hospital was of a very sick baby 48 hours old, with a very slow heart rate, temperature 40 degrees C (that is > 102 F), lethargic and a greyish tinge to his skin. I just went to see him 36 hours later, and already, after a few doses of antibiotics IV, he is looking so much better. All the nurses I met along the way were friendly and took into account the history I had for the mama and baby. Other transfers have not been so smooth. One thing that is reassuring, every time we have transfered the women and the babies have come back to the clinic to let us know how they are, tell us their birth stories and receive follow up care. To me this means that despite and/or because of the decision to transfer, they trust us and appreciate the care we offered all the way up until and during the transfer process.
Here's to greater interdisciplinary collaboration, from traditional midwives practicing in small, remote village situations, to homebirth midwives or registered midwives or nurse midwives or family doctors doing maternity, to obstetricians and pediatricians practicing at hospitals, both those small, underfunded, undersupplied institutions like the one here in Jacmel, to those larger, well equipped ones in cities throughout the world.
Friday, June 18, 2010
Tuesday, June 15, 2010
A 24 hour snapshot ...
So it has been a week since my last post, literally been catching babies constantly and sleeping in shifts. I think I have gone to bed between 3-4am the majority of the week, including another all nighter... only this time I couldn't stay uo for the antenatal clinic the next day because I was so roasted. That particular night we had 3 women labouring, and it was like a chorus, rising and falling almost in unison. 'Mezami' they would cry (meaning loosely, 'my friends' or 'help me' depending on who you ask). Two had been labouring most of the day, but when the 3rd came in actively at midnight, they all got going again. As Bonnie, this awesome Oregon midwife, and I lay listening to the sounds and reflecting on the accoustics of a dome birth centre, and they all, as if on cue, went quiet and slept. Their labours all continued to ebb and flow throughout the night, with Bonnie and I changing our bets on who would go first every hour or so. In the end, it was an almost a dead tie between a gravida 5 (had birthed 4 children at home, this is her fifth) and the double VBAC (meaning she had 2 previous c-sections, no vaginal births yet) who came in fully dilated at 6am; they birthed within minutes of each other. All told, we had 10 births in 72 hours (alot for a new, small birth centre), and many random drop in kids with diarrhea, pregnant women with vaginal infections or 'pain' and even one of the construction guys desperate for solutions for his wife's swollen gums (not even pregnant, suggested salt water gargaling, which he says is working!).
But the 24 hours I wanted to describe are more recent. Yesterday, pediatric clinic was somehow harder than other days. Every sick baby or small child seemed to challenge all our resources and knowledge. From the distinctly down syndrome baby who came in at 7 weeks postpartum with his 48 yr old mother who literally eats once a day and has no idea (at least as far as I can tell) that she has a special baby; to the two kids covered in openly scabbing 'wounds' that we decided were impetigo; to the post partum check ups for all the many babies born this week at Bumi. I was tired, irritable and feeling way in over my head. But on the bright side, it was one of the translator's, Darlene's birthday. So she was in fine form and we were all looking forward to the release of a little party celebrating her and another translator, Marie Antoinette, who's birthday was the day before. When we finally got out of the clinic, it was 4pm. We went down to the house and all cracked a cold beer or coca cola, depending on our preferences. There were ballons and music and soon we were all dancing our hearts out.
That is until one of the security guards came running in saying a patient had come in 'chaud' (this means in really active labour). I didn't grab anything, but just ran up the hill, and sure enough by the time I got there, the baby had been born. She had made it to the clinic, to have a friend catch the baby. I got there minutes later, settled her down and waited for the placenta. Luckily, she wasn't a bleeder and when the 2nd midwife got there, once the placenta had been born, she sent me back to the party. By this time, however, the party had dispersed somewhat, so I showered and hung out with those who had stayed. Just as we were lighting the candles for the cake, the midwife who was at the clinic with another labouring woman, called and said she was starting to push, so again, I ran up to the dome. This time, however, the woman was nowhere near ready. She laboured hard all night and we encouraged her to alternate between rest and activity. She was heavily supported by her husband and her brother (the first predominately male supported birth I have attended here). Her mother, meanwhile, was praying heavily to Jesus in various parts of the dome, sometimes even entering into what I can only describe as a trans-like state. As this G3 laboured, her birthing history seemed to be catching up with her. She had a normal birth in 2002, but the baby died at 2.5 years of ages of seizures. Then in 2007 she had a stillborn at 32 weeks, delivered (apparently?) by forceps at the local hospital. We wanted so badly to help her heal and have the birth she deserved. Without a translator, I was doing my best in my wierd French-Creole to support and encourage her, while Bonnie took charge of the clinical aspects. When she had been pushing for ages, with little progress, we started to get worried, and sure enough the next internal exam seemed to indicate she might have a breech presentation. Now I want to be all about vaginal breeches, but I have only attended 2, in Zambia, neither of which I managed. We decided to transfer to the hospital, at 0200. After loading her in the truck, we climbed in the back and set off. Arriving at the hospital I was shocked to find the spot where the maternity department had been just a few short days before, was now a demolished building surround by barbed wire. This is all too typical, with the redevelopment happening in spurts, but was anxiety provoking to say the least since we were trying to get our labouring mama some help sooner rather than later. The dad pushed away the barbed wire and I saw that in fact the maternity building was in tact and that it was the building next to it that had been destroyed. The hospital midwives greated us less than enthusiatically and we carried the women into the delivery room for their assessment. They kept her, stating they were sure the head was down and that she had a swollen cervix and we had to say goodbye and hope for the best. We hoped and prayed that by the time we returned in the morning, she would have a live baby in her arms, however it was meant to be born.
Back home for 3 hours of sleep before heading up to the hospital to see her. Only before we left for the hospital, the 2 traditional midwives who had brought in their client just a few days before and with whom we had shared a magical birthing experience, showed up with a massive bucket of mangos for us. We had been planning to go and visit them in Bassin Bleu (about 30 minutes away) but clearly my French-Creole understanding was off and they wanted to come and visit us here. We sat and exchanged ideas on birth for over an hour and they left with a few packages of gauze and some candles, to continue the good work they are doing (we had given them gloves after the birth). We headed to the hospital and found out that our mama had given birth to a lovely 6lb baby girl, who had yet to breastfeed but had had her ears pierced already! Likely they gave her 'pit' (oxytocin, a drug which is used regularly here to help get strong contractions) but we didn't really get the full story because the relationship between the hospital and our clinic is a work in progress. Again, she was overjoyed to see us, and promised to come to follow up with us at clinic on Friday.
From there Bonnie and I headed on our afternoon out to these amazing deep blue pools, reknown in the area. It was a crazy ride with both of us on the back of a motorcyle, through a river (never forded a river on a motorbike before) and up a steep mountain, to a peaceful oasis where we floated and felt a million miles away from sweating, birthing and cultural negotiations. It was the perfect escape, for 2 hours, and then we were back on the bikes, streaming down the mountain, getting updates on the Brazil vs Northern Korea game (Haitian's love the Brazilian team)via groups of locals listening to the game on the radio.
And now I am here, writing this hoping that the rain that just fell, doesn't push too many new mamas into labour, as sometimes weather changes do. And that maybe, just maybe, I will get more than 3 hours of sleep tonight ...
But the 24 hours I wanted to describe are more recent. Yesterday, pediatric clinic was somehow harder than other days. Every sick baby or small child seemed to challenge all our resources and knowledge. From the distinctly down syndrome baby who came in at 7 weeks postpartum with his 48 yr old mother who literally eats once a day and has no idea (at least as far as I can tell) that she has a special baby; to the two kids covered in openly scabbing 'wounds' that we decided were impetigo; to the post partum check ups for all the many babies born this week at Bumi. I was tired, irritable and feeling way in over my head. But on the bright side, it was one of the translator's, Darlene's birthday. So she was in fine form and we were all looking forward to the release of a little party celebrating her and another translator, Marie Antoinette, who's birthday was the day before. When we finally got out of the clinic, it was 4pm. We went down to the house and all cracked a cold beer or coca cola, depending on our preferences. There were ballons and music and soon we were all dancing our hearts out.
That is until one of the security guards came running in saying a patient had come in 'chaud' (this means in really active labour). I didn't grab anything, but just ran up the hill, and sure enough by the time I got there, the baby had been born. She had made it to the clinic, to have a friend catch the baby. I got there minutes later, settled her down and waited for the placenta. Luckily, she wasn't a bleeder and when the 2nd midwife got there, once the placenta had been born, she sent me back to the party. By this time, however, the party had dispersed somewhat, so I showered and hung out with those who had stayed. Just as we were lighting the candles for the cake, the midwife who was at the clinic with another labouring woman, called and said she was starting to push, so again, I ran up to the dome. This time, however, the woman was nowhere near ready. She laboured hard all night and we encouraged her to alternate between rest and activity. She was heavily supported by her husband and her brother (the first predominately male supported birth I have attended here). Her mother, meanwhile, was praying heavily to Jesus in various parts of the dome, sometimes even entering into what I can only describe as a trans-like state. As this G3 laboured, her birthing history seemed to be catching up with her. She had a normal birth in 2002, but the baby died at 2.5 years of ages of seizures. Then in 2007 she had a stillborn at 32 weeks, delivered (apparently?) by forceps at the local hospital. We wanted so badly to help her heal and have the birth she deserved. Without a translator, I was doing my best in my wierd French-Creole to support and encourage her, while Bonnie took charge of the clinical aspects. When she had been pushing for ages, with little progress, we started to get worried, and sure enough the next internal exam seemed to indicate she might have a breech presentation. Now I want to be all about vaginal breeches, but I have only attended 2, in Zambia, neither of which I managed. We decided to transfer to the hospital, at 0200. After loading her in the truck, we climbed in the back and set off. Arriving at the hospital I was shocked to find the spot where the maternity department had been just a few short days before, was now a demolished building surround by barbed wire. This is all too typical, with the redevelopment happening in spurts, but was anxiety provoking to say the least since we were trying to get our labouring mama some help sooner rather than later. The dad pushed away the barbed wire and I saw that in fact the maternity building was in tact and that it was the building next to it that had been destroyed. The hospital midwives greated us less than enthusiatically and we carried the women into the delivery room for their assessment. They kept her, stating they were sure the head was down and that she had a swollen cervix and we had to say goodbye and hope for the best. We hoped and prayed that by the time we returned in the morning, she would have a live baby in her arms, however it was meant to be born.
Back home for 3 hours of sleep before heading up to the hospital to see her. Only before we left for the hospital, the 2 traditional midwives who had brought in their client just a few days before and with whom we had shared a magical birthing experience, showed up with a massive bucket of mangos for us. We had been planning to go and visit them in Bassin Bleu (about 30 minutes away) but clearly my French-Creole understanding was off and they wanted to come and visit us here. We sat and exchanged ideas on birth for over an hour and they left with a few packages of gauze and some candles, to continue the good work they are doing (we had given them gloves after the birth). We headed to the hospital and found out that our mama had given birth to a lovely 6lb baby girl, who had yet to breastfeed but had had her ears pierced already! Likely they gave her 'pit' (oxytocin, a drug which is used regularly here to help get strong contractions) but we didn't really get the full story because the relationship between the hospital and our clinic is a work in progress. Again, she was overjoyed to see us, and promised to come to follow up with us at clinic on Friday.
From there Bonnie and I headed on our afternoon out to these amazing deep blue pools, reknown in the area. It was a crazy ride with both of us on the back of a motorcyle, through a river (never forded a river on a motorbike before) and up a steep mountain, to a peaceful oasis where we floated and felt a million miles away from sweating, birthing and cultural negotiations. It was the perfect escape, for 2 hours, and then we were back on the bikes, streaming down the mountain, getting updates on the Brazil vs Northern Korea game (Haitian's love the Brazilian team)via groups of locals listening to the game on the radio.
And now I am here, writing this hoping that the rain that just fell, doesn't push too many new mamas into labour, as sometimes weather changes do. And that maybe, just maybe, I will get more than 3 hours of sleep tonight ...
Tuesday, June 8, 2010
Pushing through fear ...
So, since that last crazy post, things have been up and down around here. Some folks left on Saturday, so it has only been myself and another midwife, Tania, to do births and pediatric clinic yesterday. Thankfully, another midwife arrived from Oregon today, another will arrive tomorrow and another on Thursday.
The weekend started out magically with our participation in a vodoo ceremony with an Mambo, vodoo elder, who is a family member of one of the guys who works on the building/gardening end of things. I danced my heart out, which was exactly the healing I needed. Although, evidently not enough, I guess. Or maybe it was the strength I needed to carry on...
Saturday morning saw me running up the hill to the dome, early on my own. The women, who was about to birth her 7th baby, was practically pushing as I walked in. Enough time to set up the equipment, and call the other midwife, but not enough time for her to get there! The baby came out with tons of meconium, the cord wrapped 3xs around his neck and wasn't super keen on breathing. He came around slowly, as his mama started to bleed. I of course, being alone, panicked. It sucked. As I am sure it is with everyone, something crazy happens in your work and you find yourself triggered over and over again. While the bleeding may have not been that bad (only about 700ml at this point), all I could think about was the last mama. I pulled too hard on the cord ... and yes, it broke (never happened to me before, never want it to happen again!). There I was, with my hand inside, trying to release a placenta again. Only this time, it didn't come. I tried over and over again, but it was different than the last time, it was adherent at the front and I couldn't release it. We decided to transfer to the hospital (not far, but the problem is a vehicle, because the one Bumi Sehat has is unreliable and is currently not working). Luckily the local funneral home car was available and before long I was in the back of a pickup truck, holding this women's uterus both inside and out. My arms are still sore, because it took about 45 minutes of squeezing with all my might before we were with an MSF obstetrician at the local hospital. I was shoeless, had blood up to my elbows and all over my legs and I was scared. They looked at me like I was crazy and asked if I always went without shoes ... I had my hand inside a woman who was bleeding, I wasn't thinking about my shoes! Anyways, the story turned out better than the last one, the OB was able to evacuate the last bit of placenta, but she had to work hard and she still thought there were membranes inside. The woman didn't bleed nearly as much as the last one, likely only another 500 - 700ml, and is now on antibiotics.
The best part for me was that she came, excitedly, to see me yesterday at pediatric clinic. She was happy to see me, which seemed somehow shocking, since I felt so awful about the birth. Her baby, of course, had spiked a temp, so he too is now on antibiotics. There is no testing for GBS here, a common bacteria that lives in woman's vaginas that is bengin to us/them, but can be deadly to babies. So whenever a baby spikes a temp in the first few days, antibiotics it is. And temps here are hard, because it is SO HOT, between 30 - 40 degrees at all times, but always hotter in the dome. We are constantly seeing babies with heat rashes and high temps, overheated from being wrapped up too much, so its a clinical judgement call if a baby is overheated or actually has a fever.
Sunday was quiet, if there is such a thing, spent organizing supplies, sterilizing instruments and, ugh, falling out of the hammock (sore butt!). And then just as I was about to sit down to dinner, the phone wrang. Up I went again to the dome and spent the night, with a very malnourished woman trying to birth her 3rd baby. She had been measuring small ever since we had met her at 26wks and we have been pumping her with protein powder at each visit, hoping she would be able to grow a healthy baby. In the end, baby was 2500g, which isn't that bad. But she was scared (terrified, bulging eye terrified) of something and wouldn't look me in the eye during the whole birth until I actually had to get into her face and tell her to push her baby out (it was right there, but it wasn't coming if she didn't push and we were up ALL NIGHT together). Once baby was born, she couldn't let go of her placenta, but luckily she didn't bleed much and Tania, the other midwife, kept reminding me everything was normal (thanks Tania!). Finally, again, she needed deep prompting to push out the placenta. I can only imagine the horrors that she must have lived, at some part of her life, for her to experience the birth of her 3rd child like that (she had the last 2 at home, by herself, her even coming to the clinic felt like a call for help, but I couldn't put my finger on what that was, besides the nutrition aspect). After being up all night, I did a full day of pediatric clinic. Some of the skin things that kids have here are horrific and we don't always have remedies, but we do our best. Saw alot of babies I and other Bumi Sehat midwives had caught, which is always fun. Scared one toddler out of trying anything I had to offer (kids vitamins that taste like candy, ymmy orange pedialite for diarrhea and anti-worm meds dissolved in above mentioned pedialite ... her mom took all the same to do at home, away from the scary 'blanc'.
And then, finally, to sleep, like a log throughout the night! The best part about waking up this morning was that my feet decided to catch up with the climate, and are no longer swollen. Day 12 and I am not walking awkwardly on puffy watermelons anymore. Over and out, from Jacmel.
12 days of adventures in babycatching ...
The weekend started out magically with our participation in a vodoo ceremony with an Mambo, vodoo elder, who is a family member of one of the guys who works on the building/gardening end of things. I danced my heart out, which was exactly the healing I needed. Although, evidently not enough, I guess. Or maybe it was the strength I needed to carry on...
Saturday morning saw me running up the hill to the dome, early on my own. The women, who was about to birth her 7th baby, was practically pushing as I walked in. Enough time to set up the equipment, and call the other midwife, but not enough time for her to get there! The baby came out with tons of meconium, the cord wrapped 3xs around his neck and wasn't super keen on breathing. He came around slowly, as his mama started to bleed. I of course, being alone, panicked. It sucked. As I am sure it is with everyone, something crazy happens in your work and you find yourself triggered over and over again. While the bleeding may have not been that bad (only about 700ml at this point), all I could think about was the last mama. I pulled too hard on the cord ... and yes, it broke (never happened to me before, never want it to happen again!). There I was, with my hand inside, trying to release a placenta again. Only this time, it didn't come. I tried over and over again, but it was different than the last time, it was adherent at the front and I couldn't release it. We decided to transfer to the hospital (not far, but the problem is a vehicle, because the one Bumi Sehat has is unreliable and is currently not working). Luckily the local funneral home car was available and before long I was in the back of a pickup truck, holding this women's uterus both inside and out. My arms are still sore, because it took about 45 minutes of squeezing with all my might before we were with an MSF obstetrician at the local hospital. I was shoeless, had blood up to my elbows and all over my legs and I was scared. They looked at me like I was crazy and asked if I always went without shoes ... I had my hand inside a woman who was bleeding, I wasn't thinking about my shoes! Anyways, the story turned out better than the last one, the OB was able to evacuate the last bit of placenta, but she had to work hard and she still thought there were membranes inside. The woman didn't bleed nearly as much as the last one, likely only another 500 - 700ml, and is now on antibiotics.
The best part for me was that she came, excitedly, to see me yesterday at pediatric clinic. She was happy to see me, which seemed somehow shocking, since I felt so awful about the birth. Her baby, of course, had spiked a temp, so he too is now on antibiotics. There is no testing for GBS here, a common bacteria that lives in woman's vaginas that is bengin to us/them, but can be deadly to babies. So whenever a baby spikes a temp in the first few days, antibiotics it is. And temps here are hard, because it is SO HOT, between 30 - 40 degrees at all times, but always hotter in the dome. We are constantly seeing babies with heat rashes and high temps, overheated from being wrapped up too much, so its a clinical judgement call if a baby is overheated or actually has a fever.
Sunday was quiet, if there is such a thing, spent organizing supplies, sterilizing instruments and, ugh, falling out of the hammock (sore butt!). And then just as I was about to sit down to dinner, the phone wrang. Up I went again to the dome and spent the night, with a very malnourished woman trying to birth her 3rd baby. She had been measuring small ever since we had met her at 26wks and we have been pumping her with protein powder at each visit, hoping she would be able to grow a healthy baby. In the end, baby was 2500g, which isn't that bad. But she was scared (terrified, bulging eye terrified) of something and wouldn't look me in the eye during the whole birth until I actually had to get into her face and tell her to push her baby out (it was right there, but it wasn't coming if she didn't push and we were up ALL NIGHT together). Once baby was born, she couldn't let go of her placenta, but luckily she didn't bleed much and Tania, the other midwife, kept reminding me everything was normal (thanks Tania!). Finally, again, she needed deep prompting to push out the placenta. I can only imagine the horrors that she must have lived, at some part of her life, for her to experience the birth of her 3rd child like that (she had the last 2 at home, by herself, her even coming to the clinic felt like a call for help, but I couldn't put my finger on what that was, besides the nutrition aspect). After being up all night, I did a full day of pediatric clinic. Some of the skin things that kids have here are horrific and we don't always have remedies, but we do our best. Saw alot of babies I and other Bumi Sehat midwives had caught, which is always fun. Scared one toddler out of trying anything I had to offer (kids vitamins that taste like candy, ymmy orange pedialite for diarrhea and anti-worm meds dissolved in above mentioned pedialite ... her mom took all the same to do at home, away from the scary 'blanc'.
And then, finally, to sleep, like a log throughout the night! The best part about waking up this morning was that my feet decided to catch up with the climate, and are no longer swollen. Day 12 and I am not walking awkwardly on puffy watermelons anymore. Over and out, from Jacmel.
12 days of adventures in babycatching ...
Thursday, June 3, 2010
Literally saving lives ...
So today was about as intense as it has been since I have been here. We had a woman show up in labour whom we had never met (meaning we have prenatal clinics, were woman plan to birth with us, and we have folks we just hear about us and decide to come only when they are in labour). This particular woman had 10 pregnancies, birthed 9 babies, has 5 alive and 3 who died under age 5. She had a long and slow labour, probably because her story is even sadder since she has only been able to keep one of her children and raise her herself (the others have been sent to live with relatives and friends). Before and after her birth, she offered me the only child she had at home, her 2 year old daughter.
She had a long and slow labour, probably as a result of some of her own fear about being able to provide for another baby. When she finally pushed her baby out, a large especially for Haitian standards 8lbs2oz, the shoulders (of course, for anyone who knows my history with shoulders!) got stuck. The midwife I was working with, Kelly, eventually got her by the shoulder and while she was a bit stunned by her birth, she came around easily. Her mother on the other hand, just let it all go. She bled, we estimated, 3litres, which is much more than anyone should EVER bleed. I know we all know theoretically how post partum hemmorhage is one of the leading causes of maternal mortality world wide. Here, in a tent in Haiti or a rural community far from a clinic or hospital, woman literally do die from hemmorhages. I did my first manual removal of a placenta, to try and stop the tap, but it still took a lot of herbs, drugs, manual massage, and prayers to get it under control. I am partially still in shock from the level of clinical skills I needed and from the truest sense of PPH I have ever encountered.
The irony of the day was this woman was married to the brother of another another women who birthed quickly and easily in the middle of the day, in a local taptap (truck/bus) on her way to the clinic. She came in to have her placenta delivered and burned (a method of detaching the baby from the placenta known for decreasing infections, infections that are all too common for small babies and is a common cause of neonatal mortality). She was at the clinic probably for about 2 hours, just getting a full check up and before we knew it, she was getting on the back of a motorbike (the most common form of transportation here, and literally all motos, as they are called, are taxis as well), with a pile of bananas behind her and her baby between her and her husband. The other woman has IVs and we are monitoring her around the clock.
In one family in Jacmel, a new baby boy and a new baby boy were born today, both extremely different births. I love remembering, that for me, my gift and joy in this life is one birth at a time I can be the change I want to be in this world (to borrow a bit from Mahamata Ghandi).
She had a long and slow labour, probably as a result of some of her own fear about being able to provide for another baby. When she finally pushed her baby out, a large especially for Haitian standards 8lbs2oz, the shoulders (of course, for anyone who knows my history with shoulders!) got stuck. The midwife I was working with, Kelly, eventually got her by the shoulder and while she was a bit stunned by her birth, she came around easily. Her mother on the other hand, just let it all go. She bled, we estimated, 3litres, which is much more than anyone should EVER bleed. I know we all know theoretically how post partum hemmorhage is one of the leading causes of maternal mortality world wide. Here, in a tent in Haiti or a rural community far from a clinic or hospital, woman literally do die from hemmorhages. I did my first manual removal of a placenta, to try and stop the tap, but it still took a lot of herbs, drugs, manual massage, and prayers to get it under control. I am partially still in shock from the level of clinical skills I needed and from the truest sense of PPH I have ever encountered.
The irony of the day was this woman was married to the brother of another another women who birthed quickly and easily in the middle of the day, in a local taptap (truck/bus) on her way to the clinic. She came in to have her placenta delivered and burned (a method of detaching the baby from the placenta known for decreasing infections, infections that are all too common for small babies and is a common cause of neonatal mortality). She was at the clinic probably for about 2 hours, just getting a full check up and before we knew it, she was getting on the back of a motorbike (the most common form of transportation here, and literally all motos, as they are called, are taxis as well), with a pile of bananas behind her and her baby between her and her husband. The other woman has IVs and we are monitoring her around the clock.
In one family in Jacmel, a new baby boy and a new baby boy were born today, both extremely different births. I love remembering, that for me, my gift and joy in this life is one birth at a time I can be the change I want to be in this world (to borrow a bit from Mahamata Ghandi).
Tuesday, June 1, 2010
Birthing in the dome
First I have to apologize for the last post. I couldn't figure out how to edit on my iPhone, so sorry for the grammatical errors!
I have been in Haiti for 5 days now. I arrived at the airport on Friday morning and was met and driven to Jacmel, normally a 2 hours drive, unpredictable these days with the rubble, the rains and landslides. I took us about 3.5 hours and we picked up a woman who had been hit by a taptap (the little vans used for public transportation) and took her to the hospital. Accidents happen alot here and often people stop at the dome to get basic first aid for their cuts and bruises. My fist day was full on, with prenatal clinic and a birth as soon as I got here! I caught this woman's 2nd baby. Her first one died at 1yr age from diarrhea, a unfortunately an all too common occurrence. She was strong inher labour, walking around the dome, but even though she was fully dilated, she didn't seem to want to push. All of a sudden her water broke and the baby was born with the next contraction. I am learning so many herbal and alternative remedies, including yunyan baiyo for decreasing bleeding and cord burning, a technique of cutting the cord that has lead to decrease in cord infections. A public health nurse friend of mine from Canada was doing a needs assessment in hospitals in Port au Prince and shared a story of a 1 week old baby she saw, dying of tetnus from a cord infection.
The weekend was busy with births, some of which I went to and others the other midwives, Tania and Kelly did. This weekend, Kelly will head back to the States and it will just be Tania and I. We get women dropping in he clinic day and night with different pains, which lately have been alot of urinary tract infections. The worst part of weekend was this woman who came in I the midst of chaos and I thoughtshe had a bladder infection, she came back the next morning thinking she was in labour, which she was. Her BP (for those who like details!) was 140/120, which is way to high for anyone, but with a pregnant mama it rstricts blood flow to baby and can cause all kids of problems for both mum and babe. I quickly got her to the hospital, after much confusion, becaus out car wouldn't star, she didn't want to ride on the back of a moto (the most popular way to get around) and so we finally hailed a random car and they picked us up. Unlike many other places, the hospital is super close, 5-10 mins. Nonetheless we found out today the baby did of survive the birth. The woman was 14 years old and 7 months pregnant. Some other woman who lost their babies at birth have continued to see us for postpartum care, I hope she does. Unfortunately before I saw her about the ?bladder infection, she had not had any antenatal care. Another all too common story here in Haiti.
Monday we had pediatric clinic and I saw a few mums and babies who had birthed with Bumi, and I saw olde kids. There was a woman with 5 kids who came with them all,she and her mother-in-law live in a tent with all the kids dice her husband died what Haitians call le catastrophe. I also saw a mama who thought she was in labour, who was pregnant for the 4th time, each of the other pregnancies ending in miscarriages at 7months, 5months and 4months. We communicated in Spanish because she usually lives in the Dominican Republic, as many Haitians do to earn money.
I has been ridiculously hot, something like 38degrees in the dome during the day. I have sweat pouring off me, but imagine the labouring women! There are solar powered fans for the windows of the dome, but they are stuck in Philiadelphia, because shipping has become very beaucratic these days, a source of great frustration for anyone trying to do relief and development work.
I will write again soon, with the intermittant Internet! Thanks to everyone again for helping me get here, this is exactly where I need to be right now!
I have been in Haiti for 5 days now. I arrived at the airport on Friday morning and was met and driven to Jacmel, normally a 2 hours drive, unpredictable these days with the rubble, the rains and landslides. I took us about 3.5 hours and we picked up a woman who had been hit by a taptap (the little vans used for public transportation) and took her to the hospital. Accidents happen alot here and often people stop at the dome to get basic first aid for their cuts and bruises. My fist day was full on, with prenatal clinic and a birth as soon as I got here! I caught this woman's 2nd baby. Her first one died at 1yr age from diarrhea, a unfortunately an all too common occurrence. She was strong inher labour, walking around the dome, but even though she was fully dilated, she didn't seem to want to push. All of a sudden her water broke and the baby was born with the next contraction. I am learning so many herbal and alternative remedies, including yunyan baiyo for decreasing bleeding and cord burning, a technique of cutting the cord that has lead to decrease in cord infections. A public health nurse friend of mine from Canada was doing a needs assessment in hospitals in Port au Prince and shared a story of a 1 week old baby she saw, dying of tetnus from a cord infection.
The weekend was busy with births, some of which I went to and others the other midwives, Tania and Kelly did. This weekend, Kelly will head back to the States and it will just be Tania and I. We get women dropping in he clinic day and night with different pains, which lately have been alot of urinary tract infections. The worst part of weekend was this woman who came in I the midst of chaos and I thoughtshe had a bladder infection, she came back the next morning thinking she was in labour, which she was. Her BP (for those who like details!) was 140/120, which is way to high for anyone, but with a pregnant mama it rstricts blood flow to baby and can cause all kids of problems for both mum and babe. I quickly got her to the hospital, after much confusion, becaus out car wouldn't star, she didn't want to ride on the back of a moto (the most popular way to get around) and so we finally hailed a random car and they picked us up. Unlike many other places, the hospital is super close, 5-10 mins. Nonetheless we found out today the baby did of survive the birth. The woman was 14 years old and 7 months pregnant. Some other woman who lost their babies at birth have continued to see us for postpartum care, I hope she does. Unfortunately before I saw her about the ?bladder infection, she had not had any antenatal care. Another all too common story here in Haiti.
Monday we had pediatric clinic and I saw a few mums and babies who had birthed with Bumi, and I saw olde kids. There was a woman with 5 kids who came with them all,she and her mother-in-law live in a tent with all the kids dice her husband died what Haitians call le catastrophe. I also saw a mama who thought she was in labour, who was pregnant for the 4th time, each of the other pregnancies ending in miscarriages at 7months, 5months and 4months. We communicated in Spanish because she usually lives in the Dominican Republic, as many Haitians do to earn money.
I has been ridiculously hot, something like 38degrees in the dome during the day. I have sweat pouring off me, but imagine the labouring women! There are solar powered fans for the windows of the dome, but they are stuck in Philiadelphia, because shipping has become very beaucratic these days, a source of great frustration for anyone trying to do relief and development work.
I will write again soon, with the intermittant Internet! Thanks to everyone again for helping me get here, this is exactly where I need to be right now!
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