Haiti Experience by Leslie Fehan, CNM

I hadn’t been back to Haiti for 12 years. I wasn’t sure really why this happened. It became clear as my time with Midwives for Haiti unfolded. One thing I remembered and was nervous about was the Port au Prince airport. My memory was that arrival was chaotic with lots of men vying for your bags, to give you a ride, and mostly to get money from you.  Not much different this time, though we did have our Midwives for Haiti connection: Ernst. As men grabbed our bags he wrangled them back and directed us sternly to follow him. Once outside the airport, safely with our driver, I could breathe.

Midwives for HaitiWe arrived in Hinche after a 3-hour bumpy ride in the back of a land cruiser that was modified to accommodate lots of people and bags. We sat on benches and hung on as the car navigated huge holes, rocks and curvy mountain roads. The Midwife for Haiti house is located about 1 km from the St. Therese hospital in Hinche. It is protected by a concrete wall and a metal gate. The house itself is quite welcoming, and I was excited to get settled.  A quick tour and meeting staff and the other volunteers for the week. I was to be sleeping on the top bunk. That will be interesting for my 54 year old self who gets up at least once a night for the bathroom. Well, I thought, maybe less chance of insects in the top bunk. My roommates were another midwife and 2 nurses from Minnesota. All 3 of these woman come at least annually to volunteer with Midwives for Haiti. I felt reassured that they would guide me during the week.

Sunday we went to church with about 1,000 other people at the Cathedral, we toured Hinche, including the market. We briefly toured the hospital. Hospital is a very loose term. It is designed with no inside hallways. Patients are in wards: with 8-10 patients grouped together. L&D consisted of 1 triage room that was like a closet, a long rectangular room about 20×9 with 4 exam tables. These tables all had stirrups, so I hesitate to call them beds, as it was just half a bed. No air conditioning or fans. I was to be at the hospital on Monday. I was nervous.

Monday off to the hospital with Wendy, the other midiwfe. I cared for a 16 year old girl in labor with her first baby. No prenatal care. No idea of gestational age. Her fundal height was 30 cms. Patient said she “9 months”, so either she wasn’t or it was a very young girl small baby. Patients have to bring all their own supplies, including a sheet to lie on. The hospital does not provide food, water or even a bucket to pee in. They also have to pay up front for care, including paying for any lab work that needs to be done.  It was so hot, I didn’t even have cool cloths or ice water to comfort this woman. She was 4 centimeters and working hard. There wasn’t much to do to lessen the pain, except physical presence and hands on care. I did try to have her walk a little and at least stand next to the bed. As she was laboring another woman came in much more active labor with her second baby. Wendy and I evaluated her and then helped her birth her baby. There were no towels to dry the baby. I had to just use my gloved hands and then I but the baby under her shirt, which luckily was cotton to keep the baby skin to sin and further dry the baby.  All was well. The sweet 16 year old was still laboring when it was time to leave. Hopefully she would have a baby sometime that evening. What challenging conditions to bring life into the world.

Tuesday was mobile clinic and home visits. Mobile clinic consists of 4 skilled birth attendants, me and 2 interpreters travelling to an area and using someone’s house or a church to provide prenatal care to the area women. We all piled in the back of the Land cruiser: sitting on those hard benches and bumped and bounced over rough dusty roads.  We traveled to Rhody and held clinic back some dirt roads in some person’s house. While moms waited on the concrete porch, we set up exam tables, laid out concrete stepsmedications, and supplies for evaluations. Approximately 30 women were waiting to see us. Clinic started with singing and a prayer, then one of the attendants did nutritional teaching. My initial job was to do vital signs on all the women. One woman had a blood pressure of 170/100: I let the attendants know, and they started an IV, gave her Hydralazine and then gave her IM Magnesium. She was then transferred to the hospital. I was amazed, and felt like we truly saved that woman and her baby with this prenatal clinic. All the woman had HIV testing done, none were positive that day, they had Gonorrhea and chlamydia testing and given prenatal vitamins and Iron. After all the vitals were done, I joined one of the attendants and checked fundal heights and fetal heart tones.  It was fun and gratifying to help woman connect with their babies and hear their baby’s heartbeat. We travelled back to the Midwives for Haiti house, had lunch rested a little then off for home visits. With one of the nurses we travelled on the back of a moto with Pleazure our interpreter and navigator. There are no road signs, no house numbers, no street names. Finding someone’s home is truly a special skill. We did 2 home visits, assessing moms and babies, doing postpartum teaching and lactation support. The women lived in small 1-2 room concrete houses, no running water or electricity. They were all well-kept, babies cleaned and dressed and mostly joyful. To say it was hot in these small windowless spaces is an understatement. I was dripping sweat and the mothers seemed unfazed.

Wednesday was the same with mobile clinic in the morning and home visits in the afternoon. This time we did clinic in Savon

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Helene, but again in some person’s home. This was a much bigger clinic with approx. 80 women. Same start to the day with singing and a prayer. For whatever reason, the singing sounded exceptionally beautiful this day and I felt emotional as I felt the joy of these women despite their hardships.  The claustrophobic room and lack of circulating air, lent me to do all the vital sign checks outside. It was much nicer on the porch with the view of distant mountains and the chatter of women. No hypertensive emergencies today. Being these women are often only seen once, fundal heights have no context. No one knows there last menstrual period, there are no ultrasounds for dating or fetal growth. It becomes about identifying problems to save women. As the director said to me, “Saving babies is incidental”.  I would learn the truth of that later in the day.

This day, I was to do home visits on my own. Emma came with me to take photographs for Midwives for Haiti.  I was to do 3 visits of moms all about 5-8 days postpartum. The first mom had twins. She had a cesarean a week ago, babies weighed 1700 gms. These little tiny babies were sleeping in her bed. She said they were sleeping so much they were not eating. She was feeling fine physically, but having a hard time emotionally.  She preceded to tell me she got pregnant after being raped by a teacher, that she has no money, her parents are helping her now, but they cannot continue to help her. It was so sad. As I examined the babies, Baby A had a fever and baby B was severely jaundiced and obviously dehydrated. I helped mom hand express milk which we cup fed Baby B as she got Baby A to go to breast.  We referred her back to the hospital as I was very worried about both babies. Knowing she could not afford this, I gave her some money to be sure she would take the babies back. I was quite shaken up after this visit. Her story was sad, these babies were at great risk, the financial realities, the limited resources all felt heavy and seemingly unsolvable. The other 2 home visits were straight forward and mostly involved teaching.  The next Day I learned that Baby A died of sepsis, Baby B was dong ok. Another Midwife went back to visit the mom and took her a hand pump to help her express milk to feed baby. In a country like Haiti, without clean water, Breast milk is the safest option. Of course, the most affordable option too. Maintaining breastmilk truly becomes about survival.

IMG_2589Thursday morning was filled with meetings with preceptors and hospital administration. Lots of discussion about plans for Midwives for Haiti students who were starting the next week to be in the hospital. Very important to hospital administration that students dress appropriately, with no long hair, dangling earrings or long nails. The administrators pointed out the importance of students wearing the correct color scrubs to easily be identified as students.  The need to maintain hierarchy was very apparent and to reinforce the order of things. This is similar discussions that happen in the states. These points were belabored for some time. Also lots of discussion with the preceptors about having the supplies they need to teach students. As the hospital often does not have medications or basic supplies the question is should Midwives for Haiti supply these for the patients the students care for? If they supply for these patients, what about the other women who Midwives for Haiti aren’t caring for? The decision was made to bring supplies with them and if they are needed for other women when the students and preceptors are at the hospital, they will be used, but the supplies will be returned to Midwives for Haiti when the students are not there.

Afternoon visit to the Girls orphanage to teach first aid skills and visit with the girls. The orphanage houses 80 girls from ages 5-18 and is run by one woman.  We worked with the elementary school girls and taught them what to do if they have a cut, are bleeding, hit their heads, and fire safety. Then we played games and sang songs.  I think the girls and Madame enjoyed the visit and interaction along with the education.

Friday morning/early afternoon spent refreshing suturing skills to the preceptors. There are 6 preceptors who will be teaching the new class of students next the next week. There are 30 students chosen form 200 applicants. The students will be taught components or prenatal care, labor management, lifesaving skills and the recognition of problems early to transport mothers in a timely manner. Though no transportation happens quickly in Haiti.  I discussed the challenges the preceptors have with suturing, their approach to suturing and how to teach students suturing. Lots of fun teaching the preceptors to hand tie suture. They can all instrument tie, but really want to learn hand tying. Challenging to teach through interpreters. I learned these women are very skilled in making do with what they have and can provide safe care to the best of their ability in a very challenging environment

Friday afternoon we explored Bassin Blu: waterfall and swimming.  We arrived and 5 young boys instantly gathered around us, looking to be our guides to the caves above the waterfall. We were advised to only pick one, but that seemed impossible.  Our driver, Little Pleazure(Big Pleazure the Moto driver’s cousin) along with the group of boys guided us up the stairs, across a small stream to see cave voodoo things happen. I will say it was helpful to have a hand in crossing the stream, as we had to navigate along a wall that was covered with bees. Rather challenge to maintain balance crossing rocks without touching the wall.  It was a lovely end to a week of hard work & hard situations. It was lovely to enjoy the beauty of Haiti and help some young boys. We tipped them each a dollar and gave them food.

 

In reflecting the major “take aways” from the trip were:

  • Though Haiti is a very poor country, people are happy and make due with what they have.  
  • We take so much for granted in the States. Many of the concerns of pregnant woman I see are trivial in comparison to what pregnant women in Haiti have to deal with. Medical interventions save lives. Though over used in the US, vastly underused in Haiti
  • Simple things make a difference
  • Appreciate Now
  • The program Midwives for Haiti is an incredibly valuable program that is saving mother’s lives.
  • Though Painful “Saving Babies is incidental” is true. Saving Mothers is what matters. As the loss of a mother has a major negative ripple effect on families and communities.
  • and finally: I realized I hadn’t been back o Haiti because the medical trips I went on prior were unsustainable. They felt like putting a band aid on a hemorrhage. The situations felt hopeless and I felt drained. I also felt lost in what my role was to be. This trip was focused, effective and had positive lasting effects.  I returned feeling not only did I make a difference for the woman I saw but they made a difference in me.
  • I am grateful for the scholarship form One Nurse at a Time that made it possible for me to go. I hope to continue to support the work of Midwives for Haiti. I also hope others can go to Haiti and see and do.  It is in this, that we are changed and the world changes.