Friday, November 22, 2013

It's All About the Students

It has been really busy. ..and it's really all about the students. Midwives for Haiti has 23 students who are now "graduated", but students must have a certain number of signatures for each skill, verifying competencies that a "skilled birth attendant" must have, according to the World Health Organization. So, our group of visiting nurses and midwives has worked in every possible setting, intensely teaching, observing, and signing our names , in the files of Haitian students who are highly motivated to show us what they know.

On Mobile Clinic: After a bumpy and scenic Jeep ride, we opened dusty suitcases inside the standard dusty concrete church in Randejois. On re-arranged wooden pews, covered with a clean sheet, Jenn and her Haitian student examined moms and babies who had delivered in the past few baby only 4 days old, one about 11 days.. One mom had delivered at home with a matron, or untrained folk midwife. The other mom tried to get to the hospital in town, but it was her fifth baby, and it came fast, so it was born in the road. The good news is, all the moms and babies looked fine. Breast feeding going well, no one had infections, and Jenn said her student was smart and learned the newborn exam well. The ladies left with vitamins, birth control info, and baby clothes. This is the best we can do, and for local reality, it's very good.

At the hospital: On airy, shaded porch outside the hospital prenatal clinic today, we gathered 12 or so students in their bright pink scrubs, around a circle of wooden benches. As we shared trail mix, I taught on first trimester bleeding. Then Alicia reviewed the signs and symptoms of pre-eclampsia, the use of Mag Sulfate and anti-hypertensive meds, and I think she was impressed with their command of the material, as much as I was impressed with her excellent teaching. Jenn did more mother-baby assessments with her students in the postpartum area. The day went on...I gave blood at the Red Cross--a special personal tradition I observe, since traveling to Haiti makes me disallowed to give in the US. What the heck, they need it more in Haiti anyway.

In our compound classroom: In the afternoon, once the sun had really heated the house up, our entire 23-student group gathered for me to lead a lecture and demonstration reviewing suturing. We cranked up the fans while I drew on the white board, then assembled instruments, suture material, gloves, all the stuff. Then, with Dr Steve Eads, CNM Mary Martin, CPM Jenna Schmitt, and our Haitian midwife teachers, many blocks of foam were lacerated, and then repaired, first by the teachers and then by the students. It started nice and tidy, and it ended successfully, but there was a very very loud and sweaty 90 minutes when we had suturing madness!

In the evening, the house relaxed into enjoying Steve's homemade ice cream, Nadene's home-made bread, the usual adult beverages, all shared with new and old friends who work together in the house this week. It has been a great week,and each person here completely gets it: It's about the moms and babies,indeed...EVERY MOTHER COUNTS! But to really reach into this achingly lovely and struggling nation, it's all about the students.

Wednesday, November 20, 2013

Long Days, Short Story

Now We're in Hinche.
Shortest possible version of a long story....

Port au Prince to Hinche in the Jeep:
What an amazing sunset over the mountains! With a full moon rising.

Sunday: We attended graduation , a celebration of 23 new midwives, with 160 guests dressed up and packed tightly with lots of sweat, into folding chairs. Songs, dances, prayers, speeches, balloons, champagne toasts, food passed around the auditorium, and a recessional with a Celine Dion recording. The sponsor of this class is the "Every Mother Counts" organization. It was founded by supermodel Christy Turlington, and works to prevent maternal mortality around the world. Christy and many of her staff attended this graduation ceremony, and it was a pleasure to meet them and talk about the growth of little old Midwives for Haiti. She and I made a little 2 minute video for my website!

So here we have life and loveliness, along with death and the not so pretty stuff. I am so proud of my Loudoun colleagues for keeping it together on the harsh introduction. Monday morning we got the flip side of the Haitian experience. We arrived at the hospital after a very busy night. We found moms and babies lying on messy sheets on the cold tile floors outside labor and delivery--there were no beds open for them. All of the tables were filled with laboring women. I found one of our new graduates examining a young mom with the portable ultrasound: she was 9 months pregnant and we were confirming a stillborn baby. I listened for luck. On ultrasound, no cardiac motion. The last time she felt this baby move was 3 days ago. As we walked through this hospital, one woman fainted on the floor, and another broke into hysterical screams; we think a family member had just passed away. Life and death are here in our hands, but we have a truly strong team to help us all cope. By the end of the morning, Alicia had started IVs, assisted my student and me with delivery of a nice healthy baby boy, and taught an extensive lesson on pre-eclampsia management. Jenn had helped the mom on the floor breastfeed for the first time since she delivered 24 hours ago, washed her up and helped her into a clean bed, and made sure our students learned, too.
Life goes on, hand in hand with death. It hurts. It is beautiful. We are being here, now, and doing the best we can. And life goes on.

Sunday, November 17, 2013

Just the Right Thing can be a Miracle

One of the many reasons I love coming to Haiti is that I get to see miracles more clearly. Now, this depends upon one's definition of “miracles” for sure. For the more agnostic flavor of believer, it may be “serendiptious coincidences”, or some such thing. For me, it's God at work, filling needs as they arrive. I see this in my normal life in the US, too, of course, but perhaps the needs in Haiti are more dramatic, hence the miracles are too.

We arrived in Port au Prince with the most civilized, NOT-screaming and chaotic episode of baggage collection and transfer to a vehicle that I have ever had! (That's a miracle I wasn't even counting!) We went directly to Heartline Maternity Center, and Beth McHoul just about teared up that we had brought the 2 most needed professionals for the gravely ill young woman they had as a patient:a High-risk OB nurse (Alicia) to help monitor this lady, and a Lactation consultant (Jen) to try to help her make milk for her baby. 18-year old Wilna had an emergency c/section 4 weeks ago, and ever since that time, has suffered from HELLP syndrome (for the medical readers) as well as possibly a pulmonary embolus, pneumonia, or other latent infection. Fevers, pain, weakness, 4 hospitalizations that eventually sent her home un-fixed, and of course, milk is gone now.

I think this young girl is beginning to turn a corner, and in the day and half we spent there, she was up and walking around, requesting favorite foods, holding and putting her baby to breast, and pumping to help make milk. Jen did some wonderful teaching with the maternity center staff, and had this baby to breast over and over, with a supplemental feeder. She just happened to bring in her backpack some Dom Peridone, a difficult-to-obtain medicine that is the best for stimulating lactation. Alicia gave the lady a new IV site, meticulous nursing care, assessments that we eventually emailed to the American physician who is managing her, and I just hung around and gave some Depo Provera on Family Planning day. All of this is just adjunct to the amazing work of the Heartline midwives and staff, who have kept this baby and mama alive when any where else, they would have died. (Miracles.) These ladies work 24 hours to care for the women in their program, and do whatever it takes. They are the true stars of this show. Oh, and all the Haitian women who were in the program with Wilna...they pump and share their milk with this little baby, so she doesn't get much formula-- just the perfect food to save a baby's life in Haiti. Heartline rocks, and we had a wonderful, wonderful stay.
Thank you, Heartline.

Then, we met the jeep at the airport and headed into the beautiful central plateau, for Hinche. Stay tuned!

Wednesday, November 13, 2013

Life & Death. .. Simple & Complicated.

This particular blog is hard to write. I'm at my sister's dining room table in upstate New York. I see misty rain and hazy blue mountains in the distance; yesterday's snow has melted. I am here because my brother-in-law passed away suddenly and unexpectedly, a few days ago. My sister needed me, and I needed to be here with her. It's a strange thought that from this almost-winter landscape, I'll soon be seeing Haiti's mountains in the distance, but it will be warm and sunny, or else a tropical shower will move through, turning the dusty roads to mud. So, I am packing for Haiti while processing a significant death, and it makes for mixed emotions and poignant reflections. I'll have to pass them on as I go through these coming weeks.

I am prone to feel my life is complicated . My professional life is full and SO busy with work that I love: being with patients, attending births, holding babies, and even, traveling to train midwives in Haiti. It's also recently full of meetings, growth plans, a boatload of email and documents, and waking up at night hoping all the pieces are staying in place. But is that really "complicated"? I have been stopped a few times in my tracks, lately, to reflect on the life and death of things, which is, really, simple. I'm reminded to live each moment in the present, and BE present, while we are here. There is no other way to truly appreciate and honor this life we've been given.

So life goes on, and I go to Haiti November 15th, and I invite you to come along. (I think it is my ninth trip, but I'm about done counting...what's the point? I go to Haiti. Kind of often.) This trip is well-funded from several wonderful donors, so I am not ( hooray!) begging for for money this time for my expenses, but ongoing support for the programs is a huge need. The non-material kind of support is SO important-- friendship, connection, prayer; the knowledge that others have interest and support this work in their hearts, too. Thank you for traveling with me, and sharing the blog with others who may be interested in supporting Midwives for Haiti and/or Heartline Ministries...they keep on needing our help, and the work they do is amazing and important.

For the first time ever, I have travel companions from my local Inova Loudoun Hospital! Two wonderful colleagues have volunteered and found their own great donor support: Jennifer Straub,RN, IBCLC, and Alicia Miller, RNC.
Jen will teach lactation and troubleshooting breastfeeding to a number of American midwives at Heartline Ministries in Post au Prince, and then work with our midwife students at Midwives for Haiti and St. Therese Hospital in Hinche. Breastfeeding is the best way to keep a baby alive in Haiti, so great expertise in helping women breastfeed has immeasurable value.
Alicia and I will work in labor and delivery.
Alicia is a very experienced high-risk OB nurse, and her skills with these at-risk mothers in Haiti will be very helpful, both to work directly with patients, and to share her skills with students.
We will go out on the mobile clinic if we can, as well. I have a strong friendship with the Haitian midwives who work on it, and they are getting so busy these rural clinics that they can easily feel exhausted or overwhelmed. They have seen over 90 mothers at some locations in one day; they can use some help!

We hope to do some tough work, be some help, and have some joys in this week, and I look forward to them: being with dear friends in Haiti, both American ( Beth McHOUL!!! MFH folk!) and many dear Haitian friends ( Theard & family, Manno & fam, and way more!!) I've helped teach the opening of several midwife classes, but never before been able to attend the MFH students' graduation ceremony before. On Sunday, however, we will all put on our nice dresses and see a joyful celebration...stay tuned. Life-- and Haiti-- is full of joy and sorrow, and we will go out and see what's there in Haiti, next week.

Thursday, April 18, 2013

True Craziness

Hi There,

Sorry to leave anyone hanging---we came back from Haiti on Saturday. I woke at dawn, in a mosquito net and humid, sweaty bunk in Hinche, Haiti. Packed bags went into a van, and 3 airplane flights, 3 airports, later, at 1 am Sunday, we went to sleep in a lovely, carpeted room in Ashburn, Virginia, after a hot shower. This is the true craziness: just how close these 2 worlds can exist, and how far apart they can be. When I first started traveling to Haiti, the contrast was so extreme as to cause real emotional distress for me--probably similar to someone who has been in outer space! Now, it's ok. I have wrapped my head around it, at least as much as one can.
The message is only, that our neighbors-- our really close neighbors-- have a very different life. Thank you for knowing and caring about them with me. I have grown to love those neighbors, and try to help them when it's right. I feell so grateful that readers travel this journey with me. Without your support, without people who care, it would be a darker path. But truly; slowly, it's getting better in Haiti. God Bless us, every one.

Thursday, April 11, 2013

Gynecology with the Chickens and the Jeep

I think I am the only midwife I know who did gyn exams today on a massage table while chickens wandered through the exam room. At least, I hope I am, as it’s a great claim to fame (if "fame" is the right word for any of this..?!). Today I took another trip out with the pink Jeep to a mobile prenatal clinic in Rhode. This is an especially nice location, as one of our midwives hosts the clinic in the front room of her house, out in the rural village of Rhode II. Magdala is one of our most experienced midwives, and lives there with her husband, Pastor Jude, 4 biological children, and 10 orphans that they have adopted. While we rode out, Philomene told us that the lady we brought to the hospital in yesterday with severe pre-eclampsia had delivered safely, and she and her baby were both doing ok. 2 Lives saved in One Day!

I am so happy with our Mobile Clinic staff during this trip. Sometimes I get frustrated, wanting things to be tidy, better organized, and essentially, “more American”, but I’m getting to where I can see past the dust to the heart of the matter. Yes, we do this clinic out of 4 beat-up, dusty, suitcases, portable massage table, a tank of drinking water for ourselves and for the women to take their worm medicine with. Sometimes I find some expired meds in the bottom of the suitcases, and a couple chickens did walk through the room where we were working today…. BUT, oh, we got some things done that matter:
We noted a kind of gonorrhea outbreak in that village—I don’t know how many tests were positive today, but a lot. We treated the infected women with injections and oral antibiotics, and sent home medicine to treat the partners. I diagnosed and treated a kid with ringworm, and sent home medicine for him. I had a really bright midwifery student working with me, and we practiced how to determine baby position, finding fetal heartbeat with a Doppler, and measuring fetal growth in centimeters. Soon she was working successfully on her own, and speaking to the women with kindness and respect. I’ve seen such growth in the academic ability and natural skill of the students over the years Midwives for Haiti has been developing this program. (And how is it she could do this entire morning looking fresh and with all her hair in place, while I was the frizzy lady in the sweaty scrubs? I don’t get it!)
While volunteer Nurse Tina took blood pressures, weights, and taught a bit about breastfeeding, the Haitian midwives collected and performed lab tests, took histories and charted, and organized the suitcases, tossing old tests or medicines, sorting the zillion supplies and medicines in different bags. They know what medicines to give for what illnesses, and best of all, they care for these women with kindness and good humor. When all the ladies were seen and no one else was waiting on the benches on the porch, we packed it all back in the Jeep and headed “home” to Lakay Nou, our lovely compound.
Sometimes Haiti can discourage us. It is a complex culture with oh, so many problems. Progress is hard, malnutrition, material poverty (and apparently STI’s) are rampant, and the heat, dust, and roads can eat our equipment alive. But I see progress! I see bright and motivated students, competent and kind midwives, and even the suitcases are a little better organized. Midwives for Haiti has grabbed my heart, and I keep coming back to work with them, because it really, really, does help the moms and babies of Haiti live, and have a chance at a better life.

The Story of Felos

When we were here last November, we sponsored a street kid named Felos. He's an orphan who showed up at a rural field clinic with a badly infected burn. Twelve yeas old, with no parents or school, he lived literally hand to mouth . Our group of volunteers managed to enroll him at Maison Fortune, a local school/orphanage, where he now lives. We visited Maison and saw Felos on Tuesday.

He has grown and matured so much! And it makes me realize that his body was just waiting ( screaming?) for nutrition so he could grow. Now that he's fed 3 times a day, his adult teeth are coming in, he grew a couple inches, and he just looks different. Maybe it's the big smile, too! He is learning his alphabet and how to spell his name. He proudly showed us his bunk, and beside it hangs the canvas "Midwives for Haiti" bag I packed for him to take with him to Maison Fortune, when we left. It's a little dusty-- like all things here. In the states, our kids backpacks often contain electronics and packaged foods...maybe a cell phone! Felos' pack had t-shirts, underwear, toothbrush, notebook, pencils, and a set of sheets. But he sure looks happy now. It's going to be a challenge to help this kid succeed in life, but we have at least increased his survival and his happiness factors. He has school shoes, but wishes for a pair of sandals, and his feet are getting almost as big as mine. So when we leave,I think my Tevas, with the adjustable Velcro straps, will work great. Then, he can think of us when he wears them. We think of him a lot, too.

Monday, April 8, 2013

The Berry is Out, and the Moms and Babies are Fine.

Monday of a week in Haiti is generally a Threat of Overwhelm, but I think Greg and I both did ok in spite of it all.

I rode the Pink Jeep out on a Mobile Clinic with 4 of our trained Haitian midwives, 1 Haitian midwifery student, and an American RN. We saw 30+ women in Dos Palais, and had some typical Mobile clinic adventures. A woman with a Blood pressure of 170/110 came in, swollen, not feeling well at all.... I was impressed at the clear decision-making and independent function of the midwives. With very little drama, they laid her on a sheet, started an IV line, ( IV fluid bag was hung on a spare piece of lumber with nails in it), and they got the Jeep ready to transport her...all while business as usual kept going: pregnant ladies waddling in for their weight, blood pressure, HIV tests, etc.

Several new mamas came in with their new babies, all doing well. They had their prenatal care with the Jeep, but delivered at home, like most Haitian folks. So these 1-4 week-old babies were having their first check with a health care provider. I examined and taught the student simultaneously. The biggest thing I think we do is the little lecture about "nothing but the breast-- you have what this baby needs! " And the mamas love to hear how perfect he is, how everything looks normal, and that they are ok. In a place where women and babies die in this birthing time, these people are happy to be well on the other side of it. Tonight, I truly dare to believe that these little mobile clinics, with vitamins, iron, worm medicine, and some basic health screening and education, are part of the reason. Really..thank you, donors.

Other than the lady we sent to the hospital, the moms and babies looked great. No other high blood pressure, babies growing well, although I think saw a girl with twins in her belly. I did end up back in the "gynecology corner"...,( if we haven't learned the full lessons we're meant to have, yet, I guess God has a way of sending us back someplace.) Somehow I am meant to serve Haiti with a speculum, collecting chlamydia tests in a a dusty corner of a cement building with a headlamp on my head, sitting on a bucket. OK, God, Here I am. Not my favorite, but STI testing is important, and I'm doing it.

Greg hung household items on the walls, and some shelves and hooks to keep the Midwives House organized...apparently his mission, for now, is so serve Haiti with a concrete drill, getting things off the floor. Late in the day, we went to Maison Fortune Orphanage, where our friend/sponsored child Felos is now housed-- and that's a great story for another day. It's humid and I need some breeze on the porch before I get in my mosquito net!
Love & Bon Nuit from Haiti.
PS: The doctors got Mica's berry out of her ear today. It did take some drugs! Who can blame her?

Sunday, April 7, 2013

Whoopee cushion and Silly String, Left Behind

No surprise! ~the bags packed for Haiti in my dining room before leaving for the airport reached the max 49.5 lbs of stuff- and some nonessential items were left behind. No whoopee cushions or silly string got packed, this time, and a few random scrubs that don't match. But: Lots of meds, thanks to awesome donors, including Loudoun Hospital! Tools and building supplies for Greg to use. Gloves. 500 Condoms. Presents for friends in Haiti, both Haitian and American. For Americans: Chocolate, or scotch, depending on religion. Clothing and toys for Haitian friends. Mostly, supplies that help moms and babies survive a very tough life.

How many times does one travel to Haiti and not react with shock, despair, or anxiety? The answer is apparently "8", if you're me, at least. I see things getting better, see past the brokenness-- the crazy potholes and trash have always been here, and don't rattle me. But at the airport: a real, working, clean and shiny baggage claim area, complete with colorful mural artwork on the walls. Gleaming, glass-walled, Duty free shops! The parking lot clear of trash, and baggage handlers are less aggressive!, We were greeted by lovely Haitian 80-degree sunshine and breeze, and the nice aroma of garlicky beans and rice. The fact that city power is ON and AVAILABLE in both Post au Prince and Hinche-- now, that is amazing. The tent city by the river in Port au Prince is nearly gone. New houses are being built all over the place. Fresh, bright paint in many places. Some ditches are deeper, so flooding is not bad on the streets. (And it's dry season...)

I went straight to Family planning day at Heartline Ministries About 40 women got birth control, Depo shots and condoms. There was great hangout time with Beth and Tara Livesay, and the Heartline folks. After a sweet and restful evening, we rendezvoused with our gang of the Midwives for Haiti volunteers at the airport, and caught our ride to Hinche, up in the mountains.

There are definitely what Greg calls "Pictures that can’t be taken": split-second moments that pass by too quickly, or can’t be captured on film without offending or upsetting someone. Leaving Port au Prince: A family of five on a motorcycle. The crowd of street kids and adults begging at the window vehicles stopped in Port au Prince traffic, hands slowly drifting through the window and toward the backpack on the seat. The discomfort of ignoring them, and the riot of folks that will crowd around if you don’t. A group of bathers and motorcycle-washers in the river on Saturday evening—so they can be clean for church in the morning. Laundry spread all over the thorny cactus to dry. Little boys flying a kite made of plastic and twigs. At sunset, a tethered goat stretching her neck sooo far, to reach the utmost edge of green grass in her circle.

We've made it here safely, yet again; thank God!!. I don't even know what the week will hold, for me. Greg has a Honey-do-list of home improvements needed here to help the Midwives for Haiti house and compound stay organized, as it grows and grows the program. Neonatal resuscitation will be taught with the students, we have gifts to deliver, blood to donate, and friends to visit. My 3-year old god-daughter Woodmica has stuck a berry deep in her ear and doctors have been trying to get it out for a few days. We suspect anesthesia may be required, since as her daddy Theard says "she does not collaborate very well". We'll keep you updated.

Thursday, March 21, 2013

Haitian "Vacation", #8....Same Old Song & Dance

Hi again. It's me: Your midwife friend who goes to Haiti twice a year and blogs about it. Now that I'm going on Trip #8, April 5-14, I'm challenged to come up with creative, entertaining ways to blog about the Needs List. Once the trip starts, the blogging is fun. I love to stay connected, and love that others find it interesting enough to read about my work there training Haitian midwives and doing development work as best I can in a crazy, impoverished place. I love that people pray for the work and for the people doing it. Love the many forms of support, and the sense that we share this thing together.
But, gee whiz... the random list of "stuff needed" has all the charm of posting my grocery list, except that sometimes, people actually donate "groceries" to the work, and that helps a LOT! But oh, so DULL!!! Can I make a video and sing and dance this? I have no shame when it comes to Haiti; I would do it...
Heck, I've got nothing else, so let's go there in our imagination:
Picture an empty stage, a spotlight, a lady in scrubs with a long, mostly-gray braid! She bows, clears her throat, and does a little a barely decent alto she sings:

Here goes Trip 8, isn't that great?
Want to help do this thing? That is what will make me sing!
I need some methergine, it's a drug that stops hemorrhage...
OH! and some gloves: any kind will do.
Non-sterile in a box, or sterile's good, too.

(Now I am twirling and kicking my feet!)

The pregnant girls up in the hills, would like some stuff to treat their ills:
TUMS are needed, for pregnant tummies
And a pouch of dried fruit they would find very yummy!
The midwives hope for hand sanitizer, and pregnancy tests
When they get in the pink Jeep, and drive to the west. (or north, east, or south)

15 Headlamps are needed, to help midwives on night
shift work in the dark, and do their work right!
And finally, need I remind you, honey--
that the most "liquid" kind of help is money! (checks to "Midwives for Haiti")

So then, if you'd like to help with donation,
the LCM office is just the location (Loudoun Community Midwives)
To drop off these things, and know that you're trendy
Helping train Haitian midwives, beside
Your Friend,

Addendum 3/28/13:
PS: And a lot of condoms