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.