Last week here...

I began the last week here working closely with a good friend of mine from the states who came to visit and spend some time in the clinic. We saw tons of patients, he assisted on a few births and even caught his first baby! It was so awesome to have someone from home here, it made for an amazing start to what will probably be a very busy and very sad week..though I am beyond excited to see my family and friends at home who I have not seen in over 8 months! I have been taking full advantage of the fact that we got our car back and we have made a trip to the beach the last two weekends-talk about relaxation! The beach is one of the most beautiful I have seen and the fresh seafood 'caught to order' has me wondering what I need to do to make living on the beach a reality :)

Dr. Yves and Sarah with his first "catch".

 Santo our head translator and all around helpful guy graduated from the Community Health Worker program last weekend. He was the class valedictorian and I am so proud of the work he did and will continue to do for Mama Baby Haiti. He gave a great speech and we were happy to be able to support him as the staff here is definitely our family!

Congrats Santo! At the Community Health Worker Graduation.

All smiles at the beach!

It has also been very sad for me to have to tell my patients I will not be here any longer as the responses have been overwhelmingly positive...only the best wishes for my future plans, thankfulness for the treatments I have given and the results they have achieved, and gifts I never imagined would make me feel so overjoyed at this opportunity I have had here. Last week, Jacques brought me some more plantains, I got some homemade 'dulce' (Haitian sweet peanut goodness), a hat, a bag of oranges, and the best compliment ever, "after God, comes you doctor". Now, I certainly don't think that I deserve these kind words and generous gifts but there is really nothing like feeling truly appreciated along with knowing that you have been able to do something you love while making a real difference in the lives of others. Words cannot describe the feeling.

I have learned so much here, not only about being a doctor but about the Haitian culture, people and language. I know I will be back very soon and hopefully I can reconnect with many of my patients even if it is just to say hello and tell them how much they have affected my life as well.

I spent many visits pleading with this mama to stop feeding her baby sugary drinks as she is malnourished and failed to gain weight, at the last visit she met her goal weight and mama said, "I remembered what you said about the juice and I stopped giving it to her and look how big she got!" 

A sweet grandma and baby Biendie who graduated from the Medika Mamba program last week!

Beach time!

I was lucky enough to spend last Saturday at one of the most beautiful beaches I have ever seen with a group of amazing new friends I have the pleasure of spending time with in Haiti. Only about an hour (if the road was paved it would probably take half the time if that) outside of Cap Haitian is the town of Labadie which is where the Royal Carribean cruise ships docks. As a PSA, I want to show my frustration with RC for the shear fact that when they dock in Haiti, they FAIL TO TELL PASSENGERS THEY ARE IN HAITI! They say, you are on the exclusive island of Hispanola or call it Paradise Island. Passengers get off the boat, walk onto  a beautiful beach with blow up toys, chairs, bars, trampoline, roller coaster, zip line and other fun activities without ever recognizing they are docked at the poorest country in the western hemisphere. At least RC helps the city of Labadie by sending the children born there to an American run school and employ many Haitians…I guess this is a consolation to not even disclosing where people actually are. Anyway, past Labadie, you have to take a, “water tap tap” (think wooden boat with a motor) about 15 minutes around part of the island (the island that houses the country of HAITI) and you end up in a small secluded bay that is called Paradise Beach (still part of HAITI). The water is indescribable; the pictures only minimally do it justice. The clarity is beyond amazing, you can see any and everything that is in the water. I will let the photos do the talking but I felt privileged to be able to see this amazing beach Haiti has to offer.

grilled lobster, conch, octopus an plantains for less than $5 per person-YES PLEASE!

crystal clear waters...ahhhh

Yes, the water is actually this blue!

view from the water tap tap on the way to the beach

I could get used to this...

gorgeous!

Mini Update

Jacques my close to 80 year old patient brought some plantains and pineapples to the house just because he  was 'at a garden and thought of me'...I couldn't help but kiss his sweet wrinkly face.

A girl could get used to this! More goodies from a patient. I love my job :)

This last week has brought with it our new staff midwife, Sarah Taylor; three babies; 60 patients; 5 days without electricity; Youtair (one of our translators) heading to PAP to try and beg for our car back; Marie leaving for Hinche for 2 weeks and Sarah working with a TBA/matron here at the clinic. TBA's are traditional birth attendants who are trained from a young age but not formally. They usually follow other matrons and learn their skills that way. We heard all sorts of horror stories about how they practice but I had never witnessed it on my own. Sarah needed a helper for a few weeks and one of our staff suggested his family member who is a matron. She is very sweet, very religious and very much a traditional birth attendant. Sarah is working hard to teach her how we do things here and to make sure she is practicing gentle birth...it has been a learning experience that is for sure!

Dieula's son, Womanoff. She keeps asking is I can marry him but I think he is a bit young.

One of my other favorite things about living here is that the kids in the community come by and hang out, in particular the kiddos of our staff members. Womanoff is the spitting image of Dieula our cook and is one of my favorites. He helps me in the garden, plays soccer with me and of course, like all kids, asks me for, "kado" or gifts.

Carrying bamboo on a hand cart trying to turn a corner...your day is not that bad now is it?

 I rarely get to take pictures when we are in Cap as it is hard to do so without feeling like an invasive tourist. Luckily I got a chance to ride in the back of Sharon's pickup and snap shots out the side window on our way back from Shada after a clinic.

It's sugar cane season!

Only 4 more weeks! Eek!!

An update on Wideline is that she has gained another 0.2kg weighing in at 1.9kg and is doing great! They spend 4 days with us this week and it was really nice to be able to see how they are bonding and just what an amazing mother Widline is becoming.

It is really beginning to hit home that I will be leaving Haiti in 4 weeks. Exactly. I have been telling patients who have been coming to see me repeatedly that I will only have one or two more visits with them and their responses have me feeling pretty sad. One woman on Wed asked, “but who will take care of me now?” I have no answers for them as there are no new prospects for doctors to come and replace me here at the clinic. I hate the feeling of being one of those people who drops in here, works for awhile and then leaves. Where is the sustainability? Where is the continuity of care? What will become of these people now that the only free clinic in the area is no longer available to them? I have to admit I have not been sleeping that well the last few weeks as I have been consumed by the worry that perhaps I should find a way to stay longer to continue taking care of my patients here, I mean, how can I just leave!?! Deep breath Zeenia, deep breath. I know it is out of my control, I understand MBH is looking for docs and they have so far been unable to find someone, I feel certain that with the loads of education and teaching I have done with my patients leave them with more knowledge about how to stay healthy and when to seek medical care therefore empowering them immensely…but I still cannot shake all of the guilt. However I know I will be back here in Haiti and hopefully I will be able to reconnect with my patients and continue to the work I have begun here. I also recognize what elements need to be in place to create real change and I hope to be able to use this as a learning experience for future endeavors.

A proper latch can make a world of difference! Rachel and Nina talk breastfeeding in Shada.

Zaboka from one of my favorite patients, Rose!

If you all don’t know, Naturopaths Without Borders (www.ndwb.org) has become official and we will soon be coming to a resource poor country near you J In all seriousness, I am very excited that I can be a part of the groundbreaking work we will continue to do as an organization dedicated to providing quality Naturopathic health care to communities in the US and abroad who have minimal access to care. After seeing what a huge difference Naturopathic medicine has made here in Haiti I am sure that people and communities all over the world we become stronger and healthier with the education and medical care we can provide! When you give people the tools to be able to take their health into their own hands, to use local foods and plants as medicine as well as to educate them on appropriate use of pharmaceuticals (a big problem here is that you can walk into a pharmacy and purchase about anything which leads to many people buy antibiotics for everything from lack of appetite to cough to rash etc. If antibiotic resistance becomes rampant we as health care practitioners are in for some serious trouble, not to mention the inappropriate use of other more serious medications) you are giving them back the power that has been taken from them as they have to rely on others for everything from work, to medicine, to food…all the aspects of life. I hope to be able to work more on the community garden projects, educational workshops and community discussions about sexual education, nutrition, domestic violence and overall health and wellness. I would like to work on getting materials such as posters, books and teaching materials here for use as there is simply nothing here, and much less anything in Creole (this is tough though as a huge percentage of people, especially those who see me at the clinic, that cannot read or write so essentially pictures are the way to go). Sharon and I have been developing some classes for the community which I think can really be expanded into a whole series of lectures with powerpoint presentations, posters, props etc. We have such great responses from the community when we present to them and I know that it is only a matter of time before they start telling others what they have learned and others tell others and BAM! We have the makings of a revolution JDown with Tampico, I say! Access to birth control, a must! Stop feeding your infants under 6mo. water, it’s imperative! Get STI testing and treatment for all, it could mean saving a life! Ok ok, I will stop now...you get the point.

Sharon working with her translator Joseph in Shada.

This is what you look like after working all day in Shada with 50+ people in a  10x20" room with not enough water.

A special someone

It has been far too long since I have blogged but following up an amazing blog like the last one is hard work J Not to say that the last few weeks have not been great, as they always are, however sometimes it just takes a certain *something* to spark the flame that becomes a new and powerful blog. 

This week I wanted to introduce you to a young girl named Widline who came to us at 8mo ready to deliver her first child. She is a young teenage mother with no family to support her as we found out after the delivery. She stayed a few days to nurse her 1.4kg baby who we hoped would survive as we understand the chances of this are not great given the odds a baby of this size has to face. 10 days after giving birth she arrived here to inquire about why her baby was sleeping so much and not feeding, in fact the last time the baby fed well was right after birth. Marie and the other volunteers worked hard with her to get the baby breast feeding and introducing new ways to get a baby that small to get the milk in. It was very inspirational to watch all the love and energy that poured out from all the midwives and volunteers. We also had a group from Hands up for Haiti come and a wonderful OB/GYN named Dr. Malley who happened to be here when Widline came for an appt. She worked all afternoon with her on getting the baby to breastfeed and was exactly what Widline needed at that moment, a mentor or simply someone to care about her. At this time the baby had not even been named yet and so Dr. Malley and Marie helped her to think of names of people she loved or those who cared about her. She came up with Wideline as she said she had no family and no one who cared about her. This was one of the saddest things I have experienced here. Subsequently the story of her pregnancy came out and she stated the conception of Wideline had not been mutual or intended which made sense as to why she seemed so indifferent towards the baby…not to mention it is hard to bond with a baby who is saving all of it’s energy to survive so she was not very receptive or awake to outside stimulation. 

Dr. Malley formed quite a bond with Widline and offered her the Saint Christopher necklace she was given before this trip with the instructions that she should use it as protection for herself and her baby. Again, this energy and love shown to this young mother was truly amazing…Dr. Malley was asked to me the godmother which she accepted graciously and since then I have been sending her pictures and stories of Widline who comes by every 3-4 days. She was here two nights ago for a check up and also asked Marie if there was any way she could stay the night as she has no access to food elsewhere and she feels safe here. We told her she could come and stay a few nights anytime she needs, this young mother and her baby have defied all odds and though the baby is not out of the woods yet, she continues to grow stronger and healthier and yesterday appeared to finally get her suckling reflex to work properly and she breastfed like a champ! No more dribbling bits of milk into her mouth, no more hoping we can get enough nutrition into her, this baby is going to make it-I feel more certain of this every time she comes! I am so happy to have the chance to meet such an amazing young mother and her child and I am sure her story has impacted the lives of all who had a chance to meet her. We work towards making sure she has enough food to eat as it is scarce and possibly a new pair of shoes as her old ones are about 3 sizes too small. She is an inspiration and I am glad I have a few more months to get to know her.

Food for the soul

Today has been one of the best days I have had here in Haiti which is making it very hard to purchase my tickets home (I swear I am just waiting for a better price…)

I hope I was able to make her day as awesome as she made mine!

I have a few patients who I absolutely LOVE to treat. Oddly enough they are at the opposite end of the spectrum from the kiddos who capture my heart under normal circumstances. Today one women who I treat weekly for her back and leg pain came early this morning and Jason our guard came to get me to let me know she was waiting for me out on the patio. I light up when I see this woman as she is such a kind gentle soul. She is in her 70’s and always comes to appointments alone. Her children have died and her grandchildren are less than helpful. She walks with a cane, slowly and purposefully as she has intense low back pain that radiates down her leg making ambulation difficult. This morning she was her ever smiling self when I showed up dressed in my pj’s. She pointed at the bag I had lent her last week to carry her medications home in. I opened the bag and inside was 4 gorgeous coconuts and about 10 lbs of oranges and limes. She paid for a moto taxi to come this morning as she couldn’t carry everything but wanted me to have this beautiful gift. My eyes water just writing about it. There was nothing she wanted in return and there was no special occasion, she simply said, “as long as God allows me to walk I will bring you gifts.” Wow, talk about a way to start the morning! I accepted the fruit and gave her my breakfast in return.

My gifts that were made into the most delicious juice ever today!

sugar cane

I merrily went about my day (seriously it was the best adult day I have had here, as you all know I am not a fan of treating the adults but I have worked it out to basically see only the returning patients one week and I love to see how well they are doing so it makes it manageable) thinking how thoughtful it was for her to come and bring me those heavy fruits. At the end of the day a women who we see often, not as a patient but as a grandmother of a baby we treat, was waiting for me on the porch. Last week I helped facilitate an arrangement for her grandchild to stay in an infant care center called Children of the Promise as her mother is unable to care for her due to some cognitive issues. Grandma wanted to let me know how she was feeling about the situation and how she felt about the process and then took me out front to show me the four large sugar canes she brought me. Say what!?! Two sets of gifts in one day?? I really AM the luckiest girl alive J We chatted for a bit with Marie, Leonise (our translator) and Monise which was really fun, it was like girl talk mixed with match making as they were all plotting ways to get me to stay in Haiti. I had joked with Marie the night prior that if I met someone and got married I would have to stay. This pleased everyone as Marie relayed the story and they all discussed qualities I need in a man and how they were going to throw me a party and bring all of the eligible Haitian men for me to meet. I, in turn did my best, in Creole, to stay with the conversation while I pantomimed how Haitian men can dance and American men cannot…it was pure hilarity. They were laughing so hard and yelling “m’zanmi” with their hands in the air, I really wish I could have gotten a photo. Oh well, I have a mental snapshot that should last at least another 50 years.

I have been so blessed with such an amazing experience here which has transformed the way I not only practice as a doctor but how I see others and their daily struggles. There is so much love and beauty here in Haiti, how could I not come back for another round. This is like food for the soul and I am eating it up!

Patient yesterday who received a doll made by hand in the US because she was too cute not to, guess what goes around comes around.

Work hard, play hard

On Sunday night Sharon, Santo and I went out to the apartments where another friend of ours, Eyleen, lives. It was her birthday and coincidently there was a group of Haitian dancers that were coming to show off their skills that night at a small outdoor restaurant within the compound. The group was called a ‘traditional dance group’ but Santo told us that they were actually more of a specific form of dance group, one associated with the vodou culture which I have now come to realize that is very different than portrayed by the media. It is also different from the vodou religion which is a distinction that is not always made. The dancers were great and their costumes were amazing, especially the sequined red vests for the men…the drumming was awesome and we had a really great time. I am so thankful Sharon has been driving us around since we have no car, it is so very necessary to get out of this compound and I am grateful that she is so sweet.

I have been trying to get out and about more which has been good for the homesickness as well as the stress caused by running this clinic and being the only doctor here. I love my work and this job has afforded me many opportunities that I would never have been able to have otherwise but it is very demanding and stressful which I think is infinitely compounded by being here alone. On the other hand I am realizing that I will be home sooner than I think and it is freaking me out a bit. I miss the US and my friends and family terribly but I also worry about everything here…who will take care of the patients, who will make sure Dieula and Monise have a special piece of cake just because; who will buy Santo cheddar cheese Pringles and share Prestiges with Jason and le boss; who will get Marie treats from Croissant D’or? They keep telling me it will be ok because I will be back soon. I hope they are right.

On the job training

In other news, I watched Shannon, a certified nurse midwifery student and 6 year OB/GYN nurse veteran show Marie how to insert a feeding tube into a pretty listless little girl who was delivered here 10 days ago. Mom came in today for a check in and said she had not been feeding the baby, “because she sleeps all the time” and that the last time she fed well was when she was born-yikes! We were concerned about the care the baby would get at the local hospital as the most likely would have given some fluids and sent mom home, it is clear what the baby needed was to be fed and the mom needed to understand the severity of the situation. We chose to keep the baby here and work on getting her to feed while Marie talked to mom about feeding in general. Baby was unable to muster the strength to suck from the breast so Marie and Shannon helped mom pump and tried via a bottle which was not effective either. We luckily found a NG tube and Shannon gave us a little one on one tutorial! The baby by this time had her eyes open and was becoming feistier which was a huge relief. Mom is going to hang here for a few hours form some ‘inpatient care’ while they continue to educate her and get the baby some more breast milk. This just goes to show how easily education goes over the heads of patients. Marie is phenomenal about educating moms before the leave, making sure to watch for breast feeding difficulties, talking extensively about solely breastfeeding and making sure the baby feeds frequently. We also make sure we are here for the moms if they need anything and ask that they come back in 3 days for the first consult after birth. This mom failed to come back. This is one of the main pushes for a community health worker to be involved with car. Thankfully Santo will be done with his class at the end of August and we can send him out on his motorcycle to check on moms and other patients! We know that the most crucial time for the babies is the first week or two after birth and this is one great example of what happens when there is follow up on the mothers’ part. With a community health worker we will be able to track the family down and make sure things are going well…I can’t wait, it will step up our ability to care for the women immensely.

Revitalized by some community education!

Yesterday Sharon (my friend and nurse at the local Hospital St. Fraciose) made the rounds to talk about STI's. First we spoke at a clinic within walking distance from here to a group of 20 or so medical students, nursing students and auxiliary community health workers. They had many questions and seemed to find the information valuable. The doctor in charge asked us to come back next week to speak on Malnutrition signs and symptoms. They even had a some light refreshments for us and the group afterwards which was very sweet!

Making food for all the children

Afterwards we headed to Shada which is a place Sharon has kindly taken under her wing. This is not small under taking as it is an area of about 4000 who live in severe poverty and despair. They are unable to feed themselves and their children and most are unable to attain any amount of medical care. I always invite them to come here but it is about 35 minutes away and it is hard to come when most families have many children to take care of. We showed up and Madanm Bwa who is our main contact there and a traditional birth attendant greeted us, she is also one of the most amazing people around. She was getting ready to complete her second day of 'free cooked lunch' for the children of the area. With the help of donations from Food for the Poor (rice and beans) and with money from friends and family of Sharon's they were able to purchase vegetables, stoves to cook the food and fruit for the children. Some of the local women cooked and viola! food for 250+ kids. It was awesome and heartbreaking to watch the children line up for what was probably their first meal of the day and most certainly the most complete meal they have had in a long while. Not a drop of bean sauce or grain of rice went to waste. I would love to be able to help Madam Bwa do a meal like this at least once per week for these kiddos.

So many kids so much love.

After the meal we gathered some women and spoke about STI's. It was completely different from the group of students we spoke with earlier in the day as many of these women have never been to school and don't have access to testing and other medical resources. They had many questions which Sharon and I did our best to answer. I also offered to come back in two weeks and bring medications to treat certain STI's if the women would go and get tested. They seemed very happy to have this option and maybe this is another incentive to get everyone tested for HIV and Syphilis, both are free tests. HIV meds are given free by the local hospitals though many people have still never been tested. I really hope this starts a movement of women getting tested for things like Chlamydia, Gonorrhea, Syphilis, HIV and Trich.

The talk turned to the use of condoms and they all began to laugh and talked about how the men refused to wear them. They also talked about lack of access to contraception due to financial constraints and how the med were unwilling to help out. It seemed par for the course that the men would use force if they wanted to have intercourse and the women didn't as well as the fact that the men were providing food for the women and if they tried to make the man wear a condom or get tested or abstain, they would not be able to eat. In one woman's own words, "if I don't do it, he beats me and my children don't eat." This is not a situation of a woman staying with an abusive significant other because she can't leave physically, this is a story of survival in which women must rely on these 'men' to eat and to be able to feed their already malnourished children. Many want contraception as they know they cannot afford another child however there are no programs offering these services for free and in Shada which is considered the slums of Cap, if it is not free it is not affordable.

Kids love photo ops!

With our lovely group of ladies in Shada

A view of the water from Shada

I left feeling like I needed to come up with a plan for these women and that we need to invest time in education throughout the community, including the men. The women laughed when we proposed this but Sharon and I said we would seek them out and talk to them one by one if need be, that this behavior is unacceptable and that these women are strong and have each other to rely on if need be. They are beautiful women who can say 'no' and have their words respected. Though at the end of the day, we get to go home to our comfortable beds in our safe houses while these women live in a world full of desperation, abuse and hunger.

Look who made it to the Dominican Republic after all...

After all was said and done with the car (well, after they took it and we came home and went to a BBQ to lift our spirits) I decided that I wanted to make the trip to the DR without the car and so we set out the next day via Caribe tours bus to the DR. The bus is very nice, air conditioned (a little too efficiently) with nice comfy seats and complete with a little snack to tide you over. The bus ride is significantly longer than driving as you have to stop at the border and everyone gets off and has their things rifled through which put the ride at about 5 hours. We lost an hour heading in the DR but I was not going to let that bring me down, we took a taxi to the hotel (oh wow, talk about culture shock-hotel was super nice and really all I wanted to do was lie in the comfy bed with the blankets pulled up around me with the air conditioning and television on...you can see where my priorities lie). We decided to head out to dinner and chose a rice little "steak house".  Now keep in mind this was Santo's first time out of Haiti...he was like a little kid and I was so happy to be able to experience it with him. When you live your whole life in a country like Haiti with only stories about other places in your mind, I can only imagine what it is like to travel-even if it is just across the border. 

My favorite moment came when we were in the hotel and we were about to get into the elevator and Santo was looking at it and it did not even occur to me that he had NO idea what these large steel doors and enclosed area were. He politely asked me to show him how it worked and to explain what it was. I realized that there is just simply so much we take for granted and I am thankful that I had the opportunity to grow up in the U.S. with all its luxuries.

What is this thing!?!

 It is hard to imagine but here people that have not traveled outside of Haiti really have no idea about what things are like since TV and movies are mostly filmed here in Haiti. It is no like you can easily search the internet for things either as power and internet are scarce so what you get is really limited to stories from others. As someone who has traveled quite a bit I have a hard time imagining knowing only one way of life. E

Enjoying a wonderful dinner, Santo's first non Haitian meal.

I am a foodie. I love different types of food and trying new restaurants. This has been a problem for me here in Haiti as most of the food I have come in contact with is made with the same 10ish ingredients. Don't get me wrong, it is delicious but it is all the same. As someone who can't even set her alarm clock for the same time each morning, this 'food situation' has been the hardest part of being in Haiti for 6 months. What I wouldn't give for some fat chubby Thai noodles.

I was so proud of Santo for trying this seafood and rice dish that was full of wonderful spices like cilantro ...a totally different taste from the typical Haitian fare.

All in all the trip was a success, even if it was only 24 hours and we didn't get the solar panels. I witnessed what it was like for someone to travel outside of their home country for the first time and I was able to get a few of the luxuries which made the homesickness I have been feeling a little bit better.

Customs schmustoms

Last week Santo and I embarked on a trip to the Dominican Republic for the purchase of some solar panels (yay solar!) however we only made it about an hour and a half out when we were stopped by a customs agent in Terrier Rouge, outside of Limonade. He waived me in politely, asked for our paperwork for the car and then came back out to ask us to come inside. He told us that the tax we paid on the car was incorrect due to the fact that the base price of the car was incorrect, or something like that. He said he would keep the car and that we needed to drive to a town called Ouanaminthe which is the border town, to find out how much we owed-pay it, then come back and get the car. I wondered out loud how I could do this with no vehicle and he calmly replied that he thought most people called their friends but that he was unsure as he spent most of his time in the office. He then left us to find a ride home. Thank goodness for Sharon Barefoot our good friend and nurse at St. Franciose who came to the rescue (in the ambulance and all.)

Fast forward to a week later and hiring a new translator who happens to have a friend at the police station who said he would look into things for us. He is a wonderful man who traveled with me out to Terrier Rouge today to see about getting the car back but sadly we made no progress. I am still unsure if there was really an issue with the paperwork or if this is a way to create revenue for certain people but it is frustrating and annoying to say the least. I miss the car (that we finally had fixed so I didn’t have to jump it each time I turned it on) and I miss being able to go places (like helping the ladies to the market or hiding out at the Christophe to get some emailing done). Besides letting out a string of words that would make most people blush after finding out we wouldn’t be making it to the DR, I wished for the first time since I have been here, that I was back at home where at least I know what to expect.

Please don’t feel too sorry for me though, there are still people who can’t eat daily and I am healthy and well.  

A delivery is a delivery wherever it happens..

 Last night around 6:30pm Jason came up and told us there was a woman downstairs, “li gen trache” which means she is having contractions. Marie heads downstairs and Melissa follows…usually when I woman comes in there is a good 30 minutes before anything starts happening which is usually filled with asking questions about whether the woman has been to our clinic for care or whether or not she has had HIV and Syphilis testing as well as any other pertinent history. I hung back, while I am a HUGE fan of the work we do here in the clinic I am not always intensely interested in birth-in all honesty it usually goes too slow for my ADD. As I am finishing dinner Melissa calls up after a few minutes have passes and asks if I can grab a syringe for the Pitocin which I thought was odd as that is part of the protocol laid out by the ministry of health here in regards to active management of the third stage (which is after the baby is actually coming out). I head downstairs to see the woman on a birth stool in the arms of her friend on the front porch actively laboring like a champ. Wow. How cool I thought, talk about perfect timing, although I am sure the motorcycle ride over was of no help in keeping the labor at bay. So we hung a sheet, grabbed our headlamps and flashlights and she delivered a healthy 7.4lb baby boy within 50 minutes. It was really cool too because Monise who is another non medical staff member of ours was really into the birth and gloved up and helped out like a pro, I was so proud of her and the other woman on the patio for using the resources available and making this birth as gentle and wonderful as the rest even without a bed, pillows, mats etc. I am trying to convince Monise to be trained as a midwife and that we can help train her but she doesn’t seem too interested which I am hoping will change if she sees more births and recognizes what an asset to the process she is.

Overall it was a great day and another nod to the amazing work that is being done here in Haiti by our staff. I am so happy to be part of this organization and more and more I see how our work here is impacting the community in more ways that just keeping them healthy and decreasing maternal, neonatal and childhood mortality rates. The way everyone comes together to help when they see the need is so encouraging in a world where I too often see people’s only concern being their own well being with little concern for others. This used to make me angry as I see the world in a different light I guess, however now I am learning that most people are doing the best they can. Whether it is helping someone find the correct gate at the airport or giving an extra moment to smile at someone who is having a bad day I believe most of us doing something nice for others on a daily basis. Either that or the lack of inundation by media and all outside sources has taken its toll on my brain and I am suddenly living in a make believe world. I am ok either way. I will continue to see the best in people because I believe people live up the expectations you have for them. I will also continue to lead by example not because I feel I must but because I love the work I do and I know how many people are benefiting from it. Even if one person passes on the information they have learned from us my time here is worthwhile. 

Kerosene inhalation causes health problems...be warned.

After being in Haiti for 5 months you don’t really think you are going to see many ‘firsts’ but today I did. A woman came in and sat down and began to give us her information. Her voice was very hoarse and I figured she had pharyngitis or layrnigitis. Then she begins to tell me about how when she was pregnant she really enjoyed the smell of gasoline and kerosene. I didn’t think much about it as I know that pregnancy does strange things to you but I was a little concerned that maybe it had impacted the baby. Upon further investigation that was 5 years ago when she was pregnant and she is currently ‘smelling’ or as we call it, ‘huffing’, kerosene 6-7 times per day. She is very worried as her voice has changed, she cannot eat and she cannot stop. Trying to quit for 3 days caused her massive headaches, irritability and sickness…yeah, I imagine it would. 

I felt so incredibly bad for this woman as she had no idea about addiction and that basically she had become physically, emotionally and mentally dependent on this substance. It is unlike drug addiction in the US where people understand what is happening but are too far removed to be able to do anything about it. She had absolutely no idea what was happening, she just knew she liked the smell of this product. My heart ached for her knowing that there are no ‘rehab’ programs here and that without serious intervention she would likely die from this habit. I told her I want to see her weekly which is all the time I can give to her, though part of me wants to house her here and try to get her weaned from this addiction. She has 3 children at home who need a mother who can care for them. I tried to tell her all the health risks which she seemed to really be affected by but without the knowledge of what is happening she really cannot fathom what it will be like to try and stop. I told her without any sugar coating that it was going to be one of the most if not the most difficult things she has ever done and that I would be there to help her but I am acutely aware of the drug rehabilitation rates in the US where we have facilities on every corner so sadly I fear that beating this may not be feasible. However, as long as she comes back and wants help I will work with her and do everything I can to help her get her life back. I think she was just thankful that someone finally told her about “addiction” and that she can release the self reproach she has been feeling about how she can’t just ‘stop’ doing this even though everyone else tells her she can.

 Empowerment comes in all forms I guess.

Helping Babies Breathe and other fun things.

Rainy season is among us and I for one am still as happy as a clam. It means the garden has taken a turn for the worse as it has not seen much sun for a few weeks and some of the things in the shade house developed a weird mold. I know this will pass as the sun will most certainly come out again soon and that means that everything will flourish once again. We have decided to rotate our crops and pull out all the old stuff in preparation. It was so nice to get out and do some serious work in the garden. I have not been out there enough and my goal from now on is to be out there at least one day per week working. I love working in the clinic five days per week but it just does not allow for enough time to do all the housekeeping things I need to do and allow me to work in the garden AND most importantly, to have a day to just lay around and read. So once it is just me in the clinic I will most likely work 3-4 days per week in the clinic, have one day for gardening here or out in the community and the (fingers crossed) have one day where the electricity is on so I  can complete all the emailing, form creating etc that I want to get done. Wish me luck!

The few remaining plants that made the cut

Time for some new crops!

Awesome teaching tools from Helping Babies Breathe

Today as I sit at the fancy schmancy hotel Roi Christophe, I am excited about a program I just finished participating in called Helping Babies Breathe. It was put on and funded by a hospital in Florida and was designed to teach neonatal resuscitation to the medical community using a specially designed infant model, ambu bag and suction bulb. It was only the second time this class was offered and I am thankful I was able to attend so I can now teach Marie and Santo these techniques and they can continue to teach others. The idea is to get as much of the community who is involved in births as possible to learn about resuscitation and provide them with the tools (i.e specialty ambu bag) so they can be prepared the event that the baby does not begin to breathe on its own.  The program was taught by Dr. Tom Lacy and I believe it will be easily recreated when I teach others here at the clinic. There are not too many steps, not too many facts and values to remember and not too many places for error throughout the process. This is of the utmost importance if you are training those in the community without medical training which is the category in which the majority of those doing homebirths fall into. We were sent home with the teaching kit, the doll and 8 suction and ambu bag kits-how cool!

Busy busy!

This week has felt busier than most, I have a awesome ND student Shayla here with me which has been great and has really helped in getting patients seen effectively. We also hosted a group who flew up from PAP for a few nights to check out MBH. Lisa is a midwife and she was traveling with Holly a nurse, Nick a pre-med student and Ashley another young traveler willing to help out wherever she could. It was fantastic that they were here, especially on Tuesday when the clinic was packed. I mean packed. We did prenatals and clinic on the same day so there were at least 20 clinic patients (10 with parents and/or siblings) and 25+ prenatal patients hanging out in the “waiting area” which overflowed to the other deck as well as any place there was to sit. We were also doing a trial run with two new translators as we are hoping Santo gets chosen for the community health worker program which leaves us without a translator as Guy is on vacation this week. So, needless to say there was a lot going on. Of course, 2 laboring mamas also came in-one expecting twins. It was so nice to have the help of Lisa, Holly, Nick and Ashley while all of this was going on! They helped with vitals, prenatals, monitoring of the mamas and anything else we threw their direction. I was thankful for their willingness to help where they were needed as well as to be able to ‘self start’ and find things to do and ways to be helpful while I was busy with patients. They finally finished prenatals at 5:30pm…one of the latest days yet!

Nick, Holly, Ashley and Lisa

Lisa and one of the mamas who delivered here

Neither laboring mama gave birth here, one was not ready and the mama with twins had some complications that resulted in us sending her to the hospital. Never fear though, another baby girl was born last night so Marie had plenty to do as always.

Yesterday was a difficult day for me in the clinic as there was a Medika Mamba patient who failed to gain weight again, leading me to have to interrogate her grandmother about who is eating her food. I am hopeful that her answer about a little diarrhea and not feeding her any formula along with the Mamba is the truth. I also had a very sweet timid 14 year old girl who had just started here menstrual cycle come in to see us. Along with this coming of age-rite of passage if you will, was another symptom, the most concerning I have seen yet. She has a large, solid, firm, non mobile, painless mass with ill defined borders in her breast that appeared one month before. The mass was the largest I have seen and I was instantly struck with concern about its features. I talked with them about the need for imaging to be done asap and that if they needed help after the imaging was complete with understanding the results or other aspects of the possible treatment I would be here for them. I am praying to whoever listens that this is simply a benign fibroadenoma though I am ready for the news of something worse if it comes. I know they will come back as soon as they get the imaging done and I plan to keep researching and striving to learn more about breast conditions as it was really a scary situation for me. In times like this I am even more thankful that in the U.S. we are able to get the help we need, even if it comes with a price. If this turns out to be something that requires removal and treatment I fear the prognosis is grim as the facilities are lacking and the trained specialists are few and far between, mostly traveling from the U.S. a few times a year to take care of the droves of patients who await their care. I am still hopeful though, something I have learned from the Haitian people who remain optimistic that a change is coming and the futures of their children will not be as difficult and cumbersome as the generations before them.

You're fired!

This was the first week of clinic without Dr. Sarah and Dr. Sean and all things considered it went pretty well. It is always nice to be able to have your close friends working side by side with you-bouncing ideas off of an laughing about things only other docs in the clinic would find funny. Working makes me miss them more but it also makes me remember why I am here which is to help the community stay healthy. We decided to run 2 peds days and 2 adult days this week. We have more than enough patients and we are able to take most of the return patients that are really the most important ones as it is better to bring a smaller number of patients to a point of sustainable health than it is to treat hundreds minimally. Here we do something in the middle…we see all the returns that we can and we also take a few new patients each day. Today there were no returns as it was an odd day to have clinic so we saw 15 new adults. That was quite the undertaking as adults always have a slew of problems and inevitably needs UA’s, acupuncture, pregnancy tests, body work etc which adds time too. I am happy to provide the necessary care for our patients it is just part of figuring out how many patients we can take each day.  Regardless, the point of the story is that Santo and I saw 77 patients this week which is a personal record for sure!! Santo has been learning how to do intakes which allows be to be able to see twice as many patients in the same amount of time. Patients are happier and I am happier-it’s a win win. Today one of my favorite patients came back, he is the 72 year old we do acupuncture on who always gets up dancing and singing us praise for making him “young again”. He always says, “I know there are so many people that need your care, I don’t want to come unless I am sick or else I will take someone elses spot.” I have tried to assure him that we love treating him and he can come back whenever but he is insistent. Today, he had a mild cough he wanted help with. I sent him home with a months worth of fish oils, multis and some vit C. He was grateful as was I that he is doing so well. He was in so much pain when we first started with him, it is really remarkable to see the progress.

Jacques, my fav!

Today seemed like the day of sexual education for me. I spoke at length about the need to use protection if you are not in a monogamous relationship and that STI’s are spread back and forth between partners if both are not treated. It was also a lesson in the lack of apparent monogamy here in Haiti. Most of the pts, men or women who I asked said they, “didn’t know” if their partner was monogamous. Huh? Excuse me? You don’t know? They all said THEY were not seeing anyone else but had no idea if their partner was. This kind of norm plus minimal sexual education make for increased diseases and need for more moments like these that can be spent teaching people about their bodies and their rights.

Today also brought my first “firing” of a patient. A woman who we see regularly has always gotten under my skin. There I said it, I am not a fan. She brings her grandson in and pulls him around, doesn’t let him speak and always tries to monopolize the visit. The grandson is visibly affected by this and I am affected by her mistreatment of him. She is also incompliant with a rising blood pressure and intermittent swelling of one leg. I have asked her many times to please go and have blood work done or at least to get on BP meds as what we are doing is obviously not working. Caveat-our treatments would likely work if she would take them and come back regularly or if she would increase her water like I asked. Anyway, she came today and wouldn’t let me get a word in edgewise about her BP, she kept telling me about her leg and back pain. I asked why she didn’t follow up or follow my instructions and again she blew me off. I finally reached my limit and I told her that if she was not going to work with me then I couldn’t work with her. I told her if she had the testing done and brought back the results or the rx for BP meds, I would consider taking her on again. I had a supervising doc in school who used to say that we should be patient and understanding of patients like this as, “that was their disease”. I agree. I also agree it is important to know where your boundaries are and what ‘diseases’ you don’t feel comfortable treating. Today I found mine.

Babies, babies everywhere!

I feel like I live in a birth center or something...wait, I do.

Marie our staff midwife has been home visiting her family in Hinche which is about 3 hours away for the last few days so it is just Dr. Allan an OB/GYN and myself here. It only makes sense that there would be a baby born every day since Marie left on Friday. I think Dr. Allan must be a lucky charm because each of the births have been phenomenally quick and easy. Even the primip (first time mama) delivered last night in 1.5hrs. Just to let you know, this is NOT the norm around here and sometimes we have women in labor for 16-24 hrs which seems like far too long for a woman to be trying to get a baby out if you ask me (says the woman who has yet to give birth). We had a woman who's water broke on the motorcycle on the way here which is always climactic and particularly interesting I am sure for the driver of the motorcycle.

Yesterday Santo and I held our first clinic with only one doc and it went really well! We had 4 Medika Mamba patients who come weekly for check ins and they have all been gaining weight steadily. One of the patients we are keeping a close eye on is a 6 month old who was being fed flour, water and sugar as her mother had passed away early in her life. The baby is growing well now as she is on formula and Medika Mamba but is still having head lag problems and some other mild delays. Each visit she appears stronger and stronger and it is really great to watch just how quickly a child will respond to proper nutrition. Santo is taking on a larger role in the clinic as well, he has learned to do intakes and yesterday I taught him to listen to the heart and lungs. I know he would be a perfect candidate for the role of a lead community health worker as he is so amazing with the patients and is a very good teacher as well. Santo and I are also taking a day long seminar in June called Helping Baby's Breath which is a neonatal resuscitation course being put on by the Cap Haitian health network and is sponsored by an American hospital. They will give supplies and training with the hopes that those trained can get out into their community and help others learn-especially traditional birth attendants and others who may be present for births. This is a huge step towards lowering neonatal mortality rates here in Haiti which is imperative, especially in a country where rates are 36 in 1000 versus for example 6.9 in 1000 in the US (which says a lot as the US has the second worst neonatal death rate in the modern world-http://articles.cnn.com/2006-05-08/health/mothers.index_1_mortality-rate-death-rate-world-s-mothers?_s=PM:HEALTH)

Our special 6 mo old pt and her weeks supply of food.

Another MM pt, her facial edema has gone down significantly since her last visit. 

Cool new project, thanks Lantern Moon!

This last week has been relatively slow here at MBH...well at least for me that is. There were two babies born within a few hours of each other on Wednesday night, one was the largest so far at 9lbs 6oz. I am recognizing that births really do come in waves as we will have 2-4 ladies come in within a few days of each other and then a little down time. I don't know much about moon cycles but man, when there is a full moon it seems we see many more women in labor.

I have been taking some time to organize my new life here, I moved into my own room which has been wonderful...I really took for granted privacy and alone time! I am also beginning to write an orientation manual and some other matierals for volunteers and for the next N.D. who will take over as there is so much to know about working here that you would only fully understand if you read it or lived it. I hope it makes the transition easier for all.

Another really cool project in the wings was created by one of my oldest and dearest friends Sean. He works for a company called Lantern Moon (http://www.lanternmoon.com/) which sells handcrafted goods, specifically knitting goods but has also branched out with other beautiful items. Most of the items are made by groups in resource poor areas which is an amazing way to help many of these countries as well to give hope to those who have been marginalized for most of their lives. Sean and the owners at Lantern Moon who are simply fantastic have put together a really neat bag with the Mama Baby Haiti logo on it to sell at trade shows with proceeds benefiting MBH! It was a great idea and I am so grateful that I have such a wonderful friend who is going out of his way to help this organization. The work we do here is so important and cannot be done without funding. All services here are free and we would like to keep them that way! Thank you Sean and Lantern Moon, you rock!!

Other than that, I am just holding down the fort and working on making sure things run smoothly. I am also recovering from the BCG (tuberculosis) vaccine I received on Wednesday which is causing some flu like symptoms. Ahhh, the joys of immunizations :) Worth it though as I plan on working in community and international health care for a long time and TB is one of the diseases that is prevalent in many areas of the world that need care. I will continue to take my vitamins and relax and hope this blows over soon.

Dieula our amazing cook with Dr. Sarah, Dr. Sean and Monise, one of our other fantastic staff members.

My Haitian family with Marie our midwife and Santo the head translator.

Jason our guard and resident Spanish speaker

Our amazing staff, we like to call them 'family'.

 

What a spread for the going away party!! Everyone pitched in and it was delicious!!

                                                                     

Last trip to the beach with Dr. Sarah and Dr. Sean....