Assisting Midwives

The wall right outside the Mama Baby Haiti gate reads:
Prenatal and Postnatal Care
Center for Birth
Family Planning
Breastfeeding support

Since mid-October, I’ve been assisting the midwives at Mama Baby Haiti in Morne Rouge with births, post-partum care, well baby visits and transports to Justinian Hospital. I’ve also been providing reproductive health education to women on Friday mornings including a brief discussion about NFP. I still volunteer at Hospital St. Francois de Sales 3 days a week;  providing health education, working with the doctors and nurses to provide care for inpatients and for those who come to the a.m. clinic.  
I usually give a talk to all the patients before their vitals are taken about sanitation, cholera prevention and lifestyle choices. Today I spoke about diabetes. Many Haïtians eat a very high fat, high salt diet and I see a lot of patients come in diabetic ketoacidosis and hypertensive crisis. Today, I transferred an elderly woman to Justinian hospital who's blood sugar was 486. I knew the doctor who was on the receiving end at Justinian and hope she'll  find the care she needs. 

Mom and Aunt of baby boy who was delivered this past Saturday.
It's wonderful to support the moms and midwifes! 

This past Saturday, I was about to go for a walk with one of the midwives, when I was told a client at Mama Baby Haiti was about to push! I was happy to standby to assist and to watch the midwife and director of the center, Sarah Taylor, go into action. The baby had a shoulder dystocia, but Sarah was calm and provided the care needed to deliver a big baby boy! 

Operating Room

Upon my return to Haiti, after a 2 week break in the states, 

I was very excited to work with Dr. Sandro Visani, Urologist and Surgeon, who came to volunteer at Hospital St. Francois de Sales for a total of 5 weeks in September and October. I was honored to scrub in and assist with surgeries for his last 3 weeks. Hernias, hydroceles and circumcisions were the primary cases that this facility could support. Dr. Visani has vast experience with prostatectomies and nephrectomies but with no blood bank and other limited resources he was limited in his practice. St. Francois de Sales would love to have the capacity to provide radiology services, a full laboratory and blood services. Almost every team that comes here compliments Fr. Geordani's efforts to make the O.R.  one of the nicest ones in Northern Haiti. 

Assisting Dr. Sandro Visani in Hospital St. Francois de Sales O.R.

Interpreter Joseph Fils Inelus and myself in the O. R. 

Fanm Se Fòs Pou Ti Bebe

Fanm Se Fòs Pou Ti Bebe talk in Shada with Melissa, a volunteer with Mama Baby Haiti!
Melissa is a doula and raw foodist. She spoke about how to be in labor with less pain.  

 After a period of frustration and disillusionment in late May and June, during that time I came across several stumbling blocks and shear exhaustion, I've discovered energizing community health education talks. I adore the process of teaching and listening to the community. I've given two talks in Shada, two at St. Francois de Sales Church and several to medical/nursing students in Monte Rouge. On most occasions, I have the privilege of giving co-talks with an amazing natropathic doctor, Dr. Zeenia of Mama Baby Haiti. One of my talks is called Fanm Se Fòs Pou Ti Bebe, which by direct translation means, Woman Is Power For Little Baby. During this talk, I review the World Health Organization data regarding the top 3 reasons why neonates, and children under 5 are at risk of death in developing countries such as Haiti.  Possible preventive measures and actions plans to curb these risks are discussed by engaging the community members with questions. I've found that the questions women ask during this time really reveal cultural norms and challenges present in their communities.

Fanm Se Fòs Pou Ti Bebe talk in front of approx. 600 people involved in the local chapter of the Catholic organization Caritas at St. François de Sales Church. 

My interpreter Joseph and I in front of a group of medical/nursing students in Morne Rouge. 

Dr. Zeenia and I with a group of women, after speaking wtih them about STDs and partner violence. 

Today's typically, atypical day in Haiti involved going down to the clinic to offer a prayer and a little health talk to the paitents while the nurses took vital signs. Before giving my talk, I usually scan the crowd to see if there are any obviously critical or on the verge of critical patients. Today, there were a couple patients that I tried to advise, but they weren't critically ill.

Nurse's Day! Front row are Miss Carmel and Miss Annie!
When I see patients  Miss Annie and Miss Carmel help me write in french. 

On Nurse's Day, I had to take a pic of nurses with me in front of  Hospital St. Francois de Sales.

The nurses and I in front of the little room where vitals are taken.  I'm next to Miss Carmel!

I then went to talk to the head nurse, Miss Carmel. She engages me in conversation and teaches me Kreyol. Miss Carmel donned white on nurses day and gave out red ribbons for AIDS awareness the following week. We talked about the possibility of writing French book publishers to find out if they would donate books to the nurses and doctors here. I can't even find a drug book here in french for the nurses to look up med doses! We set up the one suction machine that works in the Chanm Accouchmant (directly translated: room delivery). Shortly after doing this, we were using it on a 6 month old boy who was grunting and flaring his nostrils. He was breathing rapidly and needed assistance clearing his airway prior to transport to a source of oxygen. We went to Cap-Haitian's main hospital, Justinian, and I sent my trusty interpreter in to see if oxygen was available. They have a few oxygen concentrators and one tank, sometimes they're all in use and there's no room in the inn; today was one of those days. The siren allowed us to pass through congested roads, past motorcyles, tap-taps and buses on the road to Milot, but not without some patience. Even the siren doesn't always clear the road for transport of a sick patient. I was so pleased when we arrived and put our patient on 5L NC. 

In Milot, I was able to go see Dieuly, the little baby I wrote about in my last post. He was tucked into his incubator with supplies and formula sitting on top. The nurses said the father visited last week. I left pleased to know both babies I've transported to Milot were being cared for! This took up the whole morning.

Sad news/Good news

Sad news first: The baby with the omphalocele passed away a day after I took his picture. The day I took his picture, it sounded like he was doing well, per Mom's report and considering his condition. He was passing the right amount of stools and was reacting like a normal neonate. We visited the mother, and there was no clear story about what happened, but with an omphalocele there can be other congenital defects that can be present, including heart defects. The mother just told us he stopped eating and then stopped breathing. We gave the mother some vitamins, a hug and asked her to come to the clinic for more when they were finished. Thanks to Kristina and Lisa both RNs at UNMH who were trying to investigate the best possible management of his case. Thanks also to my friend Sarah, who's son had an omphalocele when he was born. She also offered wonderful support and suggestions!

Good news: Earlier this month, a team from the U.S. visited Haiti for a week. Emma an EMT with Hands up for Haiti, came to Hospital St. Francois de Sales to help us figure out our ECG machine. Thanks to Emma, we can now use it, but that's just part of the good news!  I was showing Emma the pediatric unit at Justinian Hospital in Cap-Haitian, when we happened to see this tiny neonate. We found out he was HIV+ and that his mom had passed away a few days after giving birth. There was no family there to feed him and we pointed out to the staff that he had ants crawling on him and that his feeding tube had fallen out. We did our best to get the ants off of him and we thought the nurses would take care of him, but returned later that day to find out he had not been fed all day. No new feeding tube was in his nose, his IV was infiltrated up to his shoulder, and his lungs sounded like they had fluid in them. The doctors and nurses asked us if we could do anything. Justinian Hospital is a government hospital and has very little supplies, so we went to buy a $6 feeding tube and look for some lubricant. I placed the NG tube and the docs removed the old IV and tried to find another. Emma encouraged me to find a place where he would receive better care and of course I wanted this too. We were told we could not transfer him unless we talked to his father, so we left him a note to call me. Hospital St. François de Sales has no HIV prophylaxis meds and no oxygen so I knew I couldn't transfer him to our facility. He would have to go to Milot's Hospital Sacre Coeur. Thankfully I found the phone number of one of the nurses at Milot, from the only other time I visited. I called her up the next day which was Saturday and found out that we couldn't transfer the baby during the weekend. We didn't hear from the father until the next Tuesday. It seemed like timing was just right, since on Monday I was recovering from an extremely bad gut bug (the trots 14 times and an instance of rolfing once on Sunday). I'm so thankful that he survived until we were able to transfer him!

The rest of the story is below in pictures. Please pray/keep him in your thoughts. He's still very fragile and needs a lot of care. A few days ago I received an update from one of the nurses at Milot that he's still alive. She assured us that the nurses are feeding him.

Baby Dieuly born 4/20/2011. Emma, an EMT with Hands up for Haiti and I found him at Justinian on 5/7/2011.
Ants were crawling on him. He was 16 days old and his mother passed away 8 days earlier.

IV infiltrated up to his shoulder.

Dieuly's other hand for comparison. His skin was so very ghostly.

Emma, holding Dieuly after his IV was taken out and a feeding tube placed. The doctors  were trying to restart his IV.

Dieuly is so very tiny! He's proof that chest compressions work. On the way to Milot, he went into cardiac arrest, but with a few compressions he was breathing again! At Hospital Sacre Coeur, his POX sat was in the 90's. 

The doctor and nurses at Hospital Sacre Coeur in Milot trying to get an IV and labs. 

He's a fighter! He almost looks like he's trying to smile!

He's a cutie! 20 days old when he arrived at Hospital Sacre Coeur!

Dieuly's Dad! I was able to provide him with some money to care for Dieuly, thanks to my family who sent me funds!
I asked permission to use these photos and tell his and his baby's story. 

One baby's omphalocele and yesterday's story of trauma.

What a cutie pie!
The nurses here will be changing the gauze on this little one's omphalocele daily.

A few weeks ago, this baby was born and we brought him to the main hospital in Cap-Haitien thinking he would receive surgery. We placed a sterile saline dressing on this baby's abdomen with plastic wrap over it to keep it moist. I was surprised yesterday to see this baby in the clinic and decided to take these pictures. This condition is called an omphalocele.

According to PubMed, "an omphalocele is a birth defect in which the infant's intestine or other abdominal organs stick out of the belly button (navel). In babies with an omphalocele, the intestines are covered only by a thin layer of tissue and can be easily seen." It is not uncommon for this condition to be accompanied by other birth defects, so I hope to see this baby often in the clinic so I can check on him.

Wish I had the "man-made" cover for this baby omphalocele, as mentioned in the PubMed article.

You might ask, "How is this dealt with?" The following is an excerpt from PubMed: 

Omphaloceles are repaired with surgery, although not always immediately. A sac protects the abdominal contents and allows time for other more serious problems (such as heart defects) to be dealt with first, if necessary.

To fix an omphalocele, the sac is covered with a special man-made material, which is then stitched in place. Slowly, over time, the abdominal contents are pushed into the abdomen.

When the omphalocele can comfortably fit within the abdominal cavity, the man-made material is removed and the abdomen is closed.

Sometimes the omphalocele is so large that it cannot be placed back inside the infant's abdomen. The skin around the omphalocele grows and eventually covers the omphalocele. The abdominal muscles and skin can be repaired when the child is older to achieve a better cosmetic outcome.

This baby is breastfeeding and producing diapers with both pee and poo. That's a good sign!

Here's an example of a tap-tap which is the mode of transport for many Haïtians here. Many people use motorcyles and I have even seen a mom carrying her baby while she sat on the back. There are no traffic signals and the roads are in horrible condition with many potholes. Thus, we see a lot of motorcycle accident victims. Yesterday evening, I was asked to bring the ambulance to the hospital and  we quickly rushed a little girl, about 8 years old to Justinian hospital in Cap-Haitien. She was bleeding from her ears and nose. I was very concerned she might stop breathing on the way. It was dark in the ambulance and I could barely see to adjust her IVF's.  My attempt to feel her chest rise was frequently interrupted by my inability to keep myself seated.  I'm thankful to say she was still breathing when we arrived, but I don't know if she made it. She was unresponsive and her pupils were fixed. Please pray!

Mama Baby Haiti

I've realized that the 1st month's time in Haiti, I was unable to keep up on posting, so now it's catch-up time. Within the first week, I met Mama Baby Haiti, the non-profit that's located just down the road from me. The mission of these midwives and naturopathic docs is to lower the maternal, fetal and neonatal mortality rate in Haiti. They graciously agreed to let me come with them to one of their weekly rural clinics. We walked up a dirt road, past a creek, to a remote location in Morne Rouge, where people have set up a school and where a local congregation also meets on Sundays. The congregation has been trying to build a church for years, but lacks funds. The school is in bad shape, it has a roof, partial walls, broken chairs and is decorated with faux flowers that hang from the ceilings. Plastic flowers usually upset me, but these preciously positioned ornamentations sweetly hung in the breeze. I was touched by the care people have for this space.

At the school/church in rural Haiti's Morne Rouge.

The clinic quickly filled with kids and breastfeeding moms, and I assisted with assessments, taking vitals and listening to heart, lung and bowels. 
I was shocked to see how many rashes and skin infections the kids had and initially wished we had a dermatologist with us, but the 3 docs with Mama Baby Haiti confidently treated these infections. 
I learned a great deal from these doctors that day.

This little girl, about 6 years old, has a terrible infection that was treated during Mama Baby Haiti's rural clinic.

Two out of the three Mama Baby Haiti naturopathic doctors, Sarah and Sean, standing in front of this Grandmother's house. She cares for at least 8 kids and reports she struggles to provide meals.

These doctors truly care about the community in which they serve and are hard at work. I just spoke to Dr. Sean Hesler this evening, he told me they're swamped with patients and normally have to turn many away. 2 days a week they see children, 1 day adults, and 2 days are reserved for prenatal care. They have a wonderful birthing space for delivering, equipped with the essentials, in case of complications. As they treat patients, they focus on supporting the immune system.  Please visit their amazing website and blogs!

Mama Baby Haiti Website:
http://www.mamababyhaiti.org

Mama Baby Haiti Blogs:
http://www.doktesarah.com/
http://drseanx.com/

I am inspired by their hearts, physical work and their vegetable garden to boot!

Here I am my 1st week in Haiti, with Mama Baby Haiti staff and my excellent interpreter Joseph. 

Shada A.K.A. Slums of Cap-Haitien

Two weeks ago, I spent time with some dentists in Shada, the slums of Cap. Since then, I've been able to visit 3 times. Food for the Poor distributed furniture for the lone clinic there, along with 10 bags of rice and soy! I was blessed to participate in these distributions and learn about this community. Coming here is like walking into an infomericial for Feed the Children or another non-profit, except with the added sensory experience of smell. The stench is strong but the children's curiosity and beauty quickly help you ignore your olfactory system.

The people of Shada.

Shada, at the edge of the ocean.

People waiting for the dental clinic in Shada.
I went 2 weeks ago to help American dentists and to learn a technique used for cavities when little to no supplies can be found.

Timoun ak mwen (Children and me). This was my 1st day in Shada. 

Myself and Madame Bwa. Madame is a lay healthcare worker who lives and runs a clinic in Shada. 

This little girl is obviously malnourished. Her hair is red. This meal was provided by Food for the Poor and Madame Bwa. 

Food for the Poor provided rice and soy for these kids, while  the community added bean sauce, okra, oil , time and love. Madame Bwa said she had to spend her own money to provide the extra ingredients.

Beautiful children!

This little twin is not a newborn. According to her mom, she's 3 months old.

Aww! No scraps for these guys...no crumbs to give.

I spend most mornings at St. Francois de Sales clinic with some runs to Justinian Hospital in the afternoon or evenings to transfer patients. Since my last post I transported a baby born with gastroschisis, a woman in hypertensive crisis, a dehydrated boy who has a heart murmur and a woman hit by a motorcycle. The roads are in despicable shape and I'm so grateful that I'm not the driver. Since my last post, I've come to learn that the woman who drank battery acid survived and is at home! 

Ambulance Roulette

"The ambulance here is used for everything", Fr. Geordani explained to me today. 

This morning I possibly would have gone in the ambulance to the Dominican Republic to fill small oxygen tanks, but was informed that today would not be a good day to go.  Presidential elections were yesterday and conditions might not be entirely predictable. In fact Fr. Geordani used the ambulance just last night to take two people who were shot in Cap to the Domincan Republic for safety and care. Thus, I went to the clinic and started triaging. 

TANKS SANS OXYGEN

One patient came in grasping her relative's waist as she walked in. She was clearly in respiratory distress, with trach tug, flaring, grunting and RR in the 40's. The nurses didn't seem fazed in the least.  Next door to the doc we went. He ordered an H&H, stool exam for parasites and a test for typhoid. Lungs seemed clear, that is in this loud clinic. I suggested an IV and a neb. He ordered Ibuprofen for her fever and IV fluids. IV started, 2 atrovent neb treatments and 4 puffs of albuterol later, she was still retracting but less severely and lungs were clear and open. St. Francois de Sales has no oxygen except for in the operating room. That tank is gargantuan, hooked up to the anesthesia machine and I could find no way to administer it to her. In my mind I thought, "She should be transferred to Justinian Hospital in Cap.", and so I tried to convince the doctors she could brochospasm more severely in the near future and that we should consider transferring.


A few minutes later, a woman who had drank battery acid was brought in with screams of pain. Soon thereafter, we were on our way to Justinian. A couple minutes into the ride, the patient ceased to breathe and was pulseless. I started CPR while thankfully the doctor drove on the pothole laden, bumpy road, swerving around motorbikes and trucks to Justinian. No oxygen to give her, I was it. I was unable to open her jaw, so I opened her airway the best I could and breathed into her nostrils, her eyes blank and body flaccid. I thought she was gone for good as we were jostled about. I have never given CPR in an ambulance before and it was a jerky transition between compressions to administering breaths.  At about 4-5 minutes into the ride she blinked, no respirations, but a sign of hope. I shouted to my valued translator, tell her to breathe! She barely nodded no. After the quick ride, about 10 minutes, she was blinking but not breathing. I gave two last rescue breaths then she was lugged from the ambulance, into the hospital. After that, I didn't lay eyes on her.  Later today, I thought to call the American nurses that I'll be working with tomorrow in Cap-Haitien. They happened to be @ Justinian hospital and will try to check on her. 

HOPITAL ST. FRANCOIS DE SALES, VAUDREUIL

I know God's love is with us. I couldn't have known that today, of all days, we REALLY needed the ambulance here! I could have been in the DR getting oxygen or could have chosen to bring the respiratory pt to Cap. and not returned in time for the patient who really needed it. There would have been no way we could have transported the poisoned woman to Justinian Hospital quickly without the ambulance! If you pray, please do so for her and her family!  Thanks for everyone's thoughts and prayers for the Haitian people and for me individually!

Clinic and Lab Life... Anyone have any lab equipment to spare?

Patients waiting in the morning for consultation

Open Air Waiting @ St. Francois de Sales

I wanted to post these pictures earlier, but alas, 

the internet was down. Things are very different here. Nurses order lab results and possibly order medication. I'm learning about what medications they have to offer, however simple dietary changes could really benefit this community. Tampico (sugar water with juice added), kola (the name for all soda), energy drinks and coffee seem to be preferred over filtered water.  It is not uncommon for 3 year olds to be drinking coffee. So far for carbs, I can only find white bread, white rice and, THANKS BE TO GOD...at least I found bulgar wheat.  According to the nurse I'm working with, all of the following complaints warrants a stool exam: vant femal (bellyache), tet femal (headache), granfe (rash), dyare (diarrhea), or lafyèv (fever). Anyone with a fever is tested for Malaria and anyone with a fever > one week for Typhoid as well. I see a lot of UTIs, yeast infections and rashes. 

Part of the Pharmacy

Part of the current lab.

Centrifuge with it's broken buddy

New lab being built on second floor.

Spectophotometer

Lonely Microscope

The lab doesn't have the ability to run chemistries. It has one microscope, one centrifuge, one spectophotometer and no autoclave. All other equipment needs to go to the lab equipment mechanic...and there isn't one here.  The clinic has an open air waiting area which is fine on most days, except when bad weather shows it's face. Thankfully there is an x-ray machine just down the street. The nearest EKG is in Cap-Haitian. I have yet to see an otoscope/opthalmascope. Just a couple days ago I asked why there was no oxygen in the ambulance. Saturday, I'll be picking some up. Thankfully the doctors and nurses are kind and patient as I learn kreol and read up on tropical diseases.

Parish balcony, Church Door and Dogs

As promised, here are more pictures of St. Francois de Sales. I'll be posting pictures of the clinic next. Pleasant quiet breezes are found on the balcony. Goats, pigs and cows roam on the adjacent lot which serves as a dumping ground for some. However, there is also a little plot where corn is grown. The shed-like structure is where the guard dogs hang out during the day.

The parish. I live upstairs.

View off balcony.

Metal birds and flowers as entrance of church.