Moment of Silence

Though many things were the same today, in Haiti, it had a different
feeling...the one-year anniversary of the devastating earthquake of
Port au Prince. A national day of mourning, most schools and private
businesses were closed.

The breeze was still mild and warm, the roads still busy and dusty,
and food still for sale over charcoal burners on the street. As we
had no class, a group of M4H volunteers rented a truck for a short
outing to local attraction Bassin Zim, about 35 minutes away. We
bounced over rutted, unpaved roads, buying small yellow roadside
bananas along the way. We came to a beautiful waterfall, cascading
through 3 basins, down the hill out of a huge cave! Little Haitian
boys grabbed our hands and pulled us up the path to show us the full
glory of this place...including ancient figures carved in the stone
walls of the cave. Never have I seen such a sight in Haiti! It was
awesome. We rewarded the boys with bananas, cookies, and a little
money. Haiti is still full of surprises.

Back home in Hinche, Manno, Angela Ferrari and I braved the outdoor
market to buy Kreyol books, plastic shelves, scrub brushes, and
curtains for the house. Then we piled all the boxes, bags, and
ourselves on 2 motorcycles and chugged back to the house.

The day was a more reflective, less frantic one, as befits a solemn
occasion. In later afternoon, we knew the actual time of the
earthquake was near (4:45pm), so we gathered in front of Lakay Nou.
Diuny, our cook, stopped frying meat for a minute. Judnel, our
security guy, came from his seat, and joined our circle. With Nadene
Brunk, our founder, Cara Osborn, Anglea Ferrari, Terrie Glass, Reina
Galjour and her Haitian partner Blada, and I, all held our hands, and
grew quiet. As Manno translated, we just paused:

"On this anniversary, we stop to honor and remember all the people that died in the
earthquake of last year. We ask for healing for the country, and for
the ones who were injured, and the families who lost their loved ones.
And we ask that our mission can be strengthened, so that we can help
Haiti." Americans, and Haitians, we held silence in our hearts...we
wept, and we stood together in that space, under the soft blue Haitian
sky.

We hugged and touched each other, and then, we returned to our work.

Drops in the Bucket

Years ago, a Catholic Xavieran Brother named Brother Harry, began teaching English classes in a tiny Haitian village called Pandiasou, in a small convent that is to this day, without any power or worldly accoutrements. Whatever kids wanted to learn English would show up specific evenings and practice English with him. A couple star pupils were Theard Elficasse and Bastyan Emmanuel (“Manno”). I wonder, did Brother Harry ever feel discouraged, despite his faith, and wonder if his efforts made any difference? Read on, my friends…. Eventually, Theard and Manno connected with Nadene Brunk, CNM, and translated for her midwifery class in Pandiassou. The story is long, but the Midwives for Haiti program grew out of it, and Theard and Manno worked more and more often. They both married, became fathers, and their babies are all god-children of different M4H volunteers. They earned significant money, built houses, supported their families. Then, they started supporting their family’s village. First, they invited visiting doctors and health care staff to come out and do rural clinics, out of boxes, bags, helping the sick folks in the village. The biggest obstacle was the road…God, the road…it was a ditch that the truck just straddled as long as it could while climbing huge hills and boulders…then park, and boxes of meds would be walked in about a half-mile. "The guys” started an elementary school in 2009, under a mango tree, with a blackboard and some benches. Midwives for Haiti volunteers would be invited for a very, very, rough truck ride up to the village of Naran, and see the “school” they were building. First…just a roof of banana leaves and some benches. Donations helped walls get built. An outhouse with cement lining, roof and doors, was made, to keep things sanitary, then more donations, and more rooms. Doors with locks to keep the desks from being stolen. We sent money to help pay the teachers, (who worked for free, to start...) and sent notebooks, pencils, and soccer balls. They kept plugging away and emailed us photos of “graduation” each semester. The whole village would show up for these occasions. In December 09, I went out there with my new friend, and M4H volunteer , Sharon Ryan, CNM. Soon, her Mennonite church in Ohio became a major supporter. “Flower of Hope School” is now a registered Ohio non-profit, with teacher salaries paid regularly and notebooks and other supplies in abundance. About 150 kids are in class there, now. Six had Cholera in December, but no one died. So, we took a trip to Naran this week. Some of my American friends gave money for 40chlorine-based clean-water bucket systems to be purchased for 40 of the neediest families in the village. We picked up the Klorfasil buckets, and headed out there in a very beat-up, typical Haitian, hired truck. The oil pump went out about 5 miles into our journey. Oh, you know things are dire when our friend Ronel, in a 1984 Toyota Hilux that’s on it’s truly last, last legs…is the rescue vehicle. We re-loaded into Ronel's truck, and he took us out to Naran, but as we turned the curve to go up the mountain..I was stunned. The road was a real road. Yes, dirt, but drivable and graded. Theard told me that Mercy Corps had done a project in Naran, and they paid village members to improve the road. We drove, all the way to the school. I believe that the school is a huge factor that convinced Mercy Corp that Naran deserved a road, to get the kids and supplies to school. 40 families showed up to get the Klorfasil systems. Brother Harry started something truly significant, just moving ahead with what he thought would help people. His English lessons started a long story that has not really ended here… many people have acted on their belief that something good can happen if they try to do what is right. So far, it has taken us as far as a school, and a road, and some cleaner water. Let nobody scoff, today, about the concept of a “drop in the bucket.” If we all do what our hearts tell us, it can be a flood.

Lakay Nou!

Lakay Nou, Hinche

We've named it: Lakay Nou, in Kreyol... "Our Home" in English. This leamed house is now the home of Midwives for Haiti.
After years of running a program out of borrowed closets, classrooms under trees, volunteer sleeping in guesthouses and motels, we've landed.We have a home, and are starting our fourth class. Midwives for Haiti has landed like that baby giraffe, and is on the ground, running!

Therefore we're all over the map, crazy busy.
In one day:
-Vitamins/medicine/prenatal supplies loaded into suitcases and into the truck.
-Folding chairs for our classroom, nametags & blouses for the students, 5 American midwives to hospital.
-2 Haitian Midwives left for a rural mobile clinic. Still managing out of Ronel's ancient, rusty Hilux truck which hemorrhages oil and gas. We are praying for our lovely, pink, "Jeep La"! to arrive...it will not be a moment too soon.
-Class #4 with 15 beautiful,high qualified students started, prayer and singing ringing off of the concrete walls.
-Shopping til we Drop - I bought a Haitian cell phone....I guess this is a sign the relationship is getting more serious...! It's just so much easier to have one, here. My trusty guide and ride, Manno's motorycle, needed gas...it took a half-hour to find a gas station on the edge of town that had some. Filled his tank so he can run me around. Made purchase of 40 Klorfasil bucket systems to be delivered in the village of Naran tomorrow. We arranged to buy a 500 gallon water tank for the roof of our house.
Paint, brushes & rollers. Plastic baskets for recycling and storage. 6 giant bottles of water. Can't find a "stand" for the water tanks to save our life. Landlord Jean-Louis says they come from the "Old Country"...ie, the USA!

Meetings Galore-- and these are not Quaker ones!
-Landlord meeting with Jean-Louis LaFort: Many issues with house resolved... guard/security, barbed wire,doors, electrical, water tank issues. Oh, shucks....the tank we bought is not needed! Arranged to return it tomorrow and buy light fixtures for outside the house. Carpenter, electricians, consulted, haggled with, etc. Not exactly complaining, but this stuff is not like Home Depot, folks. It's a little more complicated.

Cara Osborn, inspired by advice & helpful contacts from Jean-Louis and our desperation, will try a trip to St.Marc/PortauPrince tomorrow...and try to get the Jeep out of hock in customs. Who know what sort of persuasion she may try?? She's a powerful woman who gets a lot done....and we're frantic for that darn Jeep.

Pregnant Ladies and Babies....of course!
I saw my first Haitian patient of the week: Manno's wife, Nathalie, complaining of persistent nausea...a urine pregnancy test done in the living room clarified the reason....she's expecting baby #2! We'll start prenatal care later in the week.
Second patient of the week: our cook, Diuny's one-year old baby, was vomiting, her friend told her he had an ear infection. But!--it all started this week, when she began working for us, and leaving him bottles of powdered milk to drink when she's away working during the day. A quck examination, and we quickly decided that we can't even call ourselves "Midwives for Haiti" if it involves our cook weaning her breastfed baby so she can work for us, and he gets sick from not getting breastmilk. We arranged for her to have her baby nearby in the house so he can nurse and be cared for by her little 10-year old babysitter. So M4H will have a baby in the house!! How appropriate! He's cute, fat, and healthy as can be as long as he doesn't get that nasty powdered stuff.

A "Quiet" Evening at Lakay Nou--NOT!
No, not a quiet evening....Nadene had visits from 2 different M4H-trained midwives whom she hired to staff a clinic and a family-planning education program. The 5 bags that had been delayed in New York finally arrived via Moliares' SUV, along with furniture ordered in PaP...So the evening activty became the Allen Wrench Olympics, seeing who could assemble what with a flashlight, allen wrenches, one screwdriver, and 8 cans of Prestige beer. We had a good time and now have some boxy, ugly, durable, lightweight practical furniture.

I delivered a small Xmas bottle of Scotch to next-door neighbor Xavieran Bro. Mike McCarthy at Maison Fortune orphanage. Asked him to pray for the Jeep. I am serious....non-Catholic, but consulting a priest. We need "Jeep La" really bad, folks....please do exercise whatever spiritual powers you all hoave, ye who care for us. Otherwise, and still, it's a lovely night in HInche!

God Bless.

Re-Entry

Getting off the plane in Miami, I stopped to use the ladies room before I got in the passport line. I was so distracted by washing my hands in a clean sink, with soap AND paper towels! all together!! that I walked away and forgot my bag of duty-free rum. I was admitted back in the US through the passport line, and into baggage claim, before I remembered. Eventually, a customs staff person did retrieve it for me.

My heart did a flip when I passed a barber shop in the Miami terminal. I could get my hair washed, NOW! In the twinkling of an eye and with a painless zip of a plastic credit card, I receved a manicure (goodbye, dirty fingernials!!) and a shampoo and trim of my hair. The hairdresser was Cuban and spoke mainly Spanish, but I explained I had been "doing doctor work in the mountains in Haiti" and did not have many showers. Afterwards she said "Yeah, I seen the dirt come out in the sink!!" It was such a relief to be clean. Cleaner, anyway. I had brought more from Haiti than I planned--- Haitian road dust, all the way from Hinche.

I had not eaten since peanut-butter-and-bread-breakfast that morning at Fr. Jacques' rectory, so I needed food. I found the elevator up to the main concourse, and then a directory of the shops. I stood in front of the glossy black map of the airport terminal, and glanced down the list of restaurant and food choices. And I started to cry. I looked over my shoulder at the folks in the terminal, a little embarrassed. I wanted to explain"...Sorry, you see, I've been in Haiti. And they do not have this much...this much food. Or this much choice. The leap between worlds is overwhelming." No one was bothered by my tears, however, so I wiped my eyes and found some lunch. My salad & 1/2 sandwich was served in a clear plastic box, and it was very hard to toss it away afterward. I thought: Someone in Haiti would use that box! And they would. But getting it back to Hinche would be tough. A lot of the poverty is linked to lack of transportation and roads. I hope Haiti can get better roads. I hope so many things for Haiti.

I hope that the Midwives for Haiti program will survive and grow , to become an established school that produces more and more trained practitioners that can save lives and reduce those catstrophic mortality rates. I hope that the many good people in the US know that one of their closest neighbors, in their own hemisphere, is one of the absolute poorest nations on earth. I hope the Haitians keep on trying. There is despair and anger in Haiti, but there are so many who keep doing their best, each day, not only to survive, but to succeed. There are people in Hinche, tonight, reading under every street light, working to learn and improve their lives. Danise is at home in the rectory, writing a qualifying exam to ensure that only the best, brightest students will be admitted to this program that she now teaches. She emailed and asked for a desk, so apparently she doesn't plan to leave soon. There are student midwives in a classroom, five days a week, learning how to care for women and babies with respect and kindness and skill. And Danise told me that every day, they pray for us, their friends in the U.S. And then they sing.

A Haitian Birth-day, or ,The 3 S's

Dear Nadene and Steve,

As I fly home to Dulles, I want to thank you (??!) for the casual encouragement you gave me that "it would be great if I could take some student's over to L&D and deliver a baby in Haiti" before my week was out. Well, my friends, I did that, and what an experience it was! I tend to believe God has a plan in all situations, so I guess I was meant to grasp in huge experiential detail what it's like to lack what I will now call the "3 S's ": STUFF, trained STAFF, and STABLE surroundings (like water and electricity...) The language barrier added a special thrill as well!

So, I chose the 2 students who had no birth experiences except their own. On Friday pm at 2, they dressed nicely in their pink scrubs and followed me over the the Salle Maternite. I saw no one in the delivery area, so I introduced myself to the nurse at the maternity desk as one of the "Saj Famn pou Ayiti" midwives from the US, and said I would be happy if I could help with a delivery. Of course this was thru the interpreter, so I hope that's what I said. But perhaps this meant to her " I am WonderWoman!!- Bring it ON!"...I don't know.

The nurse said that "OK they got somebody for you" and they got a laboring lady out of bed and walked her across the hall to the delivery area for me to examine. She got up on the table, I found some gloves, and examined her. Her cervix was 6 cm dilated and she was having strong contractions. She was having her second baby. While I was explaining this to my students, I was slightly disconcerted that more women were being brought in and helped onto more tables--- they kept coming!

The next one was 5 cm dilated, fully effaced, 1st baby. OK...but here comes #3. She's only 3 cm, but making lots of noise and obviously laboring actively. I was starting to feel confused...do they just hang around those tables until they deliver? What about the labor area? And the nurse who was leading the stampede was doing almost nothing to organize or help me! ( I later learned she was the only nurse for ALL the maternity patients.. including rooms full of postpartum women, including some receiving blood. Aha.) NO STAFF. So I found a doppler and started checking fetal heart rate on everybody-- let's see if all the babies are OK! They were. Praise God. Next, I figured, OK, They've already invented Group Prenatal Care: let's try Group Labor! So while lady #4 was climbing onto her table, I did a round of Blood Pressures; this was hard because it was so loud in there with all the laboring and hollering. As far as I could tell, nobody was over 140/90. The nurse asked did I want to give the one with the 140/90 BP some Aldomet? Well, No thanks, I said, but could we dip her urine? We could, and cup of urine and sticks were given to me which showed negative protein, so I decided to just watch her. I did manage to explain this to the students for minute, before lady #3 got off her table, pooped in the plastic bucket at the end of the table, and vomited on the floor...likely not 3 cm anymore!

I already understood that we had almost no help; there was nobody consistently nearby except me, my students, and our interpreter. But they were getting some labor and delivery experience, by golly!!
Now I was acutely aware of NO STUFF. NO gel for the doppler. NO Kleenex to wipe off the doppler. NO paper towels (or anything) handy to wipe up the floor. The water did work, so I did wash my hands as much as I could, but did not have towel to dry with. There were also flies around-- not quite #3, a "Stable situation". Each woman had brought some type of cloth from home to put under her on the plastic-covered table. Some had pieces of sheets, some had a night gown or a skirt spread out beneath them. Now, I understand that this is meant to get them through an entire birth, and goes home with them to be washed. The thought of a full bag of chux and a roll of paper towels ran through my mind and seemed like something I saw in another life!

Next, the infermiere brought me--WOW!--prenatal records on each of the laboring women! They had all visited the prenatal clinic at least once! Nobody had a hemoglobin under 10, and no one had tested positive for HIV, and they had all taken some vitamins at some point. No babies were coming breech, no twins; hey, It was my lucky day!

Danise came over about 3:30 and I felt like the cavalry came over the hill. I told her I was staying until Ronel came for me with the truck at 5pm, and she and the students all said they would stay with me and work. More trained STAFF! Hurray! Our lady on the third table had been getting more and more active labor...actually, at some points all the ladies were yelling and crying; quite the drama! Despite having locked away the medical boxes for the end of the week, I did have a small bag of STUFF that I'd carried with me "just in case", - I had some gloves, a gown, suture, Pitocin, Lidocaine, and syringes. I broke open a few of the diaper & onesies kits, and placed a new clean diaper under my patient who was ready to deliver. This move was greeted with disapproval by the Haitian staff, that I was using that nice clean cloth in this manner!

At this point I couldn't really communicate with anyone around me, because the birthing mom had her arms wrapped around the interpreter, screaming and pushing the baby out. God Bless her, Danise was there to help me, so we actually checked the baby's heart rate a few times, and she found me a few instruments that I can only hope were sterile; there were 2 clamps and a small scissors. Soon, we delivered a baby, a girl, and she cried right away. I had Camina stand by with a clean diaper (another one! I was tearing through the resources like a crazy person by Haitian standards) that we used to dry off the baby. We suctioned her, cut her cord, and wrapped her in a clean blanket. My heart was full of gratitude to the friends and moms who had donated all that STUFF. God bless them, too. We did active management of 3rd stage since I had the Pit, and bleeding was well controlled. Hooray for stuff and staff.

Next, the perineum needed a small repair. I was so happy that I could give this lady lidocaine for local anesthesia, as it is not routine there; I just happened to have some. HER lucky day! When I had the syringe loaded and went to inject the area for stitching, I realized I had no light but daylight. This lack, the third "S",I call STABLE Situation: the need for power & water. We angled the table so that afternoon sun gave me light. I asked for a stool to sit down on while I stitched...one was placed under my bottom, but oh dear, it was actually a seat not connected to the frame. So, with a loaded 10-cc syringe and and uncapped needle, I fell backward on my butt, onto the filthy floor...waving the syringe around and trying not to get hurt or puncture anyone! The girls caught me before I whacked my head or poked anyone,picked me up, got me on a chair. I went ahead and used the lidocaine as I felt it was still uncontaminated and that's what we had. I had the scissors and 1 small straight hemostat left, and Danise indicated that this is what I had to use to suture with. So nevermind, Steve, teaching the students the proper way to suture, with pickups! I did the repair with one hemostat and some Vicryl. The students were thrilled to observe hand ties and instrument ties, and were able to identify them as I did them!

In the end, we had caught a baby in Haiti, and I had to go home with my truck before the other ladies delivered. I was soaked in sweat and very tired! It was absolutely mind-boggling to me that this chaotic escapade, the craziest 3 hours in labor and delivery I ever spent, had actually been a big improvement over the usual birth scenario at this hospital. It's also astonishing that most of the women in Haiti do not get prenatal care, and do not deliver in any facility or with anyone with training, so that this story actually is a best-case scenario. My patient was attended by trained midwives, and had more care, more precautions against infection and hemorrhage, actual local anesthesia, and even some clean linen. Midwives for Haiti and the people supporting us can do so much better, if we keep going. I am grateful for the eye-opening adventure, and I am inspired to try to supply the 3 S's, and keep working for birth to be safer, and better, in Haiti.
Onward!