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....

Changes, they are a comin'...

Another week has come and gone and patients have been taken care of to the best of our ability. I am happy to have a few days off to relax as the next few months hold some unique changes as well as some more difficult terrain.

My dear friends and current medical directors Sarah and Sean are leaving MBH heading back to the US on Wednesday for some much needed rest, recuperation and time to figure out logistics for their next project, they are global health junkies so I am sure they will continue their work abroad in the future. This will leave me to be in charge around here for a few months until the staff midwife comes in Sept or until another N.D. comes to take over long term. I am excited and nervous for this new chapter though I feel fully prepared for the job with an excellent support network here, the staff has become like my family! I will stay here in Haiti until Aug/Sept based on scheduling etc and then head back to the US to spend some time with my family and friends who I miss terribly. It will be a culture shock no questions asked to step foot on American soil after living in Haiti for 8 mo. I guess I can look to Sarah and Sean for support as this is exactly what they are doing in less than one week…I am jealous they get to hug their families, hang out with their friends and maybe even eat some Thai food…mmm…Thai food.

I guess I am going to chalk up this new chapter as a nice fat learning experience that will enhance my ability to run clinics abroad in the future which is something I hope to be a part of. I love global and community health and I love Haiti so I am sure the next chapter of my life will encompass one of the above, if not all. There is so much to learn and I am ready to soak it all up like a sponge. I am also extraordinarily excited about having my own room, it’s little things like this that make all the difference J

Haitian Flag day and some random pics

It has been a long hot few weeks with minimal power here in Haiti. The power has decided it likes to come on in the middle of the night and then turn off before I decide to get in the shower in the morning. Thank you power, thank you. Though this is all ok as I don’t really need daily showers…I do however love the idea of a cooling fan and some computer time.

Today is Haitian Flag Day and it is a big National holiday around here. Apparently there are going to be parades in Cap and other festivities. I am hoping this also means there will be electricity as they will need a way to run their loads of speakers used during festivals, thankfully we reap the benefits as well.

As far as births go it has been a very busy time here at the clinic. We had 3 births within 12 hours and then another woman came in and delivered last night. What does this mean for the rest of us ‘non-midwives’? It means lots of birth noises, hooting, hollering, lending of headlamps/getting new batteries for them when their lights run out and waiting for the sweet sound of a crying baby-which signals the end of the above mentioned noises. I think birth is an AMAZING process and I am happy to be a part of an organization that is helping woman to have a positive birth experience. I have not been to a birth outside of this center but I hear they leave a lot to be desired. One of our midwives even had the pleasure of naming one of the babies which is commonly asked of those who aid in the births, along with asking if you will be the godmother. This is a great honor though as we found out being a godmother means a significant financial commitment which is not necessarily know upon graciously accepting the title J All future volunteers be warned, being a godmother entails paying for baptism parties, clothing and college…accept at your own risk.

Midwife Jessica and baby Tomas Lee

I love when the kids get involved...here come some zuccini, edemame, peas and carrots

Marie and Monise enjoying the beach

We went to the beach again last weekend which was awesome and much needed. It was packed with other humanitarian workers we have met along our journey here in Haiti and it was nice to see everyone taking a little extra time for themselves. Though most were still ‘working’ in some capacity, either reading about Tropical diseases, working on new projects, sitting in the shade on their laptops or emailing feverishly on their kindles (that was us). There is so much work here that needs to be done that I understand the need and drive to continue working even when you are ‘off’. The other palpable feeling is that of guilt as we sit on the beach we paid $5 to get into and sip on fresh juice while so much of the country cannot and will not ever get to experience this. I rationalize by understanding that if I am not taking time to enhance my sanity then my patients will not receive the best care. Though I admit, the guilt remains.

We love to decorate for birthdays!

Santo learns to play pool

I love being a Dr.

We have decided to move our adult clinic day to Wednesday so our translators can have every other weekend off...much to their delight I might add, the patients because adults were seen twice this week and the translators because they are some of our hardest working staff. I think it is great to have a M-F schedule as well which hopefully will allow for more sight seeing/fun and educational trips around now that we have a car. Yes, we HAVE A CAR!!! My world has opened up exponentially and I am beyond excited to have this amazing machine in my life. We can also transport patients, in particular pregnant women to the hospital which we have already done in the week or so that the car has been here. We are so happy to have it available for our use, for patient car and for Jason our poor guard who used to have to fill 5 gallon water bottles one at a time carrying them on the back of a motorcycle. Did I mention we fill about 18 twice a week?

Today was a great clinic day, in part because the power was on all day and I was able to keep the fan going which prevents sweating all over my patients...everyone involved is happier when this does not happen. I learned a few important lessons today regarding patient care. One is that you should never assume what the patient says is exactly what is happening to them and two, never underestimate the power of good medicine.

A 42 year old woman comes in with new onset frontal headaches, nausea and low back pain. She keeps referring to an "infection" that she has in her vagina which is causing these symptoms, including increased dryness and itching. She states she is drinking minimal amounts of water, eating a few times per day and having regular bowel movements.  Another concern is that her menses ceased a month ago but given her age and her lack of sexual intercourse from her history I am thinking she is probably early perimenopausal and having some of the symptoms associated with this time period. I go to do a UA and figure, what the heck, I might as well run an hCG (pregnancy test) while I have the urine in front of me. I did the hCG twice to be sure, but staring at me were two dark lines indicating this woman was pregnant. I don't know if I will ever be comfortable  telling a woman who just told me there was "no way" she could be pregnant that she is but I have done it many times while being here. Luckily we are an amazing birth center with great prenatal care as well so I told her to come back next week for care. She was not the least bit excited which I can imagine has to do with the difficulty in feeding her three kids already. This is one instance that I wished this woman had been able to get the proper education and proper family planning (given she WANTED it) as I could tell from her disposition that she was not prepared or overjoyed by this news.

A 30 year old man came in with weakness of the left side of his body, darkened urine and yellowing of the eyes. I was immediately concerned with hepatitis or other liver damage. I explained my concerns to him and asked if he could get some lab work done. In the meantime he casually says he has some pain with urination and swelling in his genitals. Ok, I go to do an exam and he reveals a swollen testicle the size of my fist...poker face...poker face...antibiotics.

Another patient of mine is a 60 something man who has concerns of pain in his leg where it is "draining". Not understanding what he is talking about I ask to see the leg and am met with a 9 inch scar that looks like Frankenstein's forehead on the later side of his thigh. The draining is actually a hole the size of the tip of a pencil that is open and draining clear liquid. This is a remnant of a surgery he had to place a metal rod in his leg years ago and has been draining ever since. Seeing no medical reason for this hole I figure, let's try and close it. We have bags of 'collagen' in tubes that is to be used on burns and wounds to help to close skin so I thought why not give it a shot. I gave him a few weeks worth of collagen, gauze and bandages along with some vitamin C, vitamin A and zinc. He came back to see me and I asked how his leg was doing, he said it was causing him less pain but still bothering him, I took a look and saw some translucent looking material on the side of the wound which initially thought was a new infection, damn, Upon further inspection I found that it was actually new skin growth around the wound which was now the shape of a crescent instead of a full circle. WOW! Medicine is amazing!!

Ironically talking about hunger while I eat my breakfast...

I have been trying to take some time in the mornings to do some yoga, stretching, reading or just simply being present and reflecting on the my work here or preparing myself for the day ahead. This also affords me the luxury of having a cup of coffee, being the only one awake and doing some great people watching from the roof. Today I was thinking a lot about last week’s clinic experience as there were a few standout patients that have stayed on my mind. They all showed up with similar concerns; belly aches and dizziness which appeared to be caused simply by hunger. But hunger is not simple. It is complex and terrible and not easily remedied and overwhelmingly present here in Haiti. I have realized it is one of the most gut wrenching things to  see patients come in with and I have found it the most difficult to understand and deal with. 

There is nothing worse than having to tell someone to save bites of food from one of their two meals (if they are lucky) to eat later in the day as their dizziness is caused by lack of food. To look someone in the eyes and say, I am sorry you are hungry and know there is nothing you can do to remedy the situation has been and will be the source of most of my unrest and sleepless nights here. We have small amounts of rice we can give to patients who are hungry and malnourished though feeding a family of four or more which is usually the case means the rice does not go very far. I have been giving people vegetables out of the garden as well which makes all the work we have done to get things to grow worthwhile but also only provides a short term palliation of the hunger, which I am completely fine with however as a long term thinker and a lover of sustainability I wish there was more I could do to help. There have been many times I have thought about going home to Oregon, selling all of my things and coming back to feed everyone with the money I made…this thought I am sure has come to many who have worked here but realistically it is not a viable option. What we need is a shift in global health and in recognizing that throwing food at a starving population is as ineffective as throwing medicine after medicine at a population who does not care to take their health into their own hands and actively work to make lifestyle changes.

No one benefits from people coming in and telling them what to do. The true benefits come from educating, teaching and creating sustainable jobs and ways for people to feed themselves.

It is common to see women carrying large baskets like this on their heads.

                                                                              View from the drive into Cap Haitien

Garden progress...

Our mounds of Bok Choy

Congo Peas gone wild!

Cabbage, onions and radishes ready to be thinned and transplanted

Shade house number one with basil, cabbage, lettuce, onions, tomatoes, mustard, peppers galore!

Scabies, Chicken Pox, Spider bites oh my!

Busy. Today was tres busy.

Dr. Sean was out with his first illness in 6 mo. (I think) and so Dr. Sarah and I saw all the patients today. Initially we were going to cut the number down as it is doable to see 10 patients each per day but more than that tends to be exponentially more difficult. Sadly, by the time we got down to ask Santo to cut the number to 20 they had already passed out 30 cards...that will teach us to sleep in I guess. 

It was a a pretty interesting day today as I saw many different diseases and conditions versus a day where everyone has a cough, headache due to dehydration and discharge of some kind. It started off with a patient Dr. Sean had seen who had presumed whip worms and as a sequlae, rectal prolapse (common with this kind of worm infestation), abdominal pain oh and vomiting up worms as well. Yum. 

The last treatment she had worked wonders and basically mom was just back because she had allergies a a mild URI.
Dr. Sean 1: Whip worm 0

Today I also saw the sweetest 2 month old with a nasty case of scabies. I was shocked when she came in as I thought she possibly had Rubella or some other viral exanthem however upon closer inspection I noticed the telltale signs of scabies. Mom was also afflicted with the little buggers so I treated them both and asked if they could follow up next week. I was also concerned that mom was only feeding her child two times per day and when asked why she was hesitant to give us any information. Digging further as I have become accustomed to I found out mom was not getting enough food and was not wanting to feed the baby as she was under the impression it would make her devoid of nutrients. I calmly talked to mom and ended up giving her some rice, vitamins and some education regarding nutrition for herself and her child. Luckily the child was healthy enough and did not appear malnourished but the idea that she was only being fed 2 times per day blew my mind. Oh, and she was also only pooping every 15 days. Poor thing, I am so glad her mother brought her to see us and now we continue to follow up on her care and make sure she is getting the medical treatment she needs.    

Zeenia 1: Scabies/Malnutrition 0

Chicken pox are making a come back around here and I saw possibly the most miserable 11 yr old with a 104 degree fever today. Luckily he came in right when the lesions began so I am sure we can shorten the duration of the pox as well as to make him more comfortable in the meantime.
I love Naturopathic Medicine.

The spider bite is my own current condition. Last night I noticed a burning pain in my right arm with swelling, redness and a distinct spider bite mark. No biggie, I get bites ALL the time here. Later in the evening the bite had swollen to a noticeably large lesion and Dr. Sarah helped me get some homeopathic cream for it. I also took a dose of Apis 30c which is indicated for bites and stings. Bed time came around and I went to sleep only to wake in the night to notice that my arm was aching, heavy and the lesion was doubled in size. I assured myself it was just the homeopathic initial aggravation before the symptoms got better. Woke up this morning and the bite was back down to it's original swollen size with some serious aching and heaviness in the arm. Took some more supplements and another homeopathic remedy and things are starting to look up for my poor arm. I can't take the win on this one though.
Zeenia 0: Spider with fangs and venom 1.

Gardens serve many purposes

Monday was a great day in the clinic, Dr. Sarah initiated our first patient into the Medika Mamba program, we saw well over 30 children and I was able to give fresh vegetables from the garden to a family who was unable to feed their children adequately…life is good I tell you…

My hopes for the garden we have here have not only been that we can feed ourselves with fresh organic veggies but also that we can feed patients as well as teach them how to garden, give them the tools they need and be a source of information if they have questions. Today I was able to make all three happen in one day! Dieula (our chef extraordinaire) has been taking it upon herself to pick us salad greens for meals from the garden. This may not seem like a big step but when none of the Haitian’s living here will eat these greens so this small gesture is quite impressive. I can understand their hesitation in eating our spicy arugula or the bitter beet greens or the foreign bok choy however my hope is that one day I will come downstairs during dinner and find a each person taking a few spoonfuls of the salad or greens for their plate…a girl can hope can’t she. So anyway, I also showed Dieula that we have green beans, green onions and basil out in the yard that she can use for cooking, all of which she was excited about using. Either that or she has gotten good at feigning excitement while I grin and talk quickly like a child who has had too much sugar.  Regardless I am happy to be able to eat out of our amazing garden.

As far as feeding patients with our food, today after the intake and treatment I took a young girl who was eating dirt and failing to gain weight and her mother out to the garden to give them some food. I was unable to provide money for them to feed their extended family (the mother runs an orphanage locally that takes care of 23 kids) but I felt good about being able to feed them from our garden. We walked around while I picked bunches of bok choy, explaining how they can use this vegetable in cooking. We also grabbed, beets, carrots, lettuce, tomatoes, chard and a few green beans. I also inquired about whether or not the family had space to garden in their yard and though mom was unsure of the amount of area she had I am pretty sure we could help them grow at least a few plants…we are planning on hooking up with them to do a village clinic for their other kiddos so we can do some recon at that time and be able to assess for garden space. It just made me so happy to use our garden therapeutically. This is something I would love to do locally at home as well, Portland is currently experiencing a “locavore” movement so it seems like people are really interested in this kind of idea.

Another patient had come in a few weeks back with his son and the gentlemen who built the shade houses had given him some seeds. I asked if he had planted them as he was excited about the prospect of having his own garden. He said he was waiting for the rain to stop as it would wash away the seeds. It has been raining here more often this last month (when I say rain I mean pouring usually then it clears up to a cloudless sunny day) so I can understand his hesitation. I offered some information about how we chose to grow some of our plants in small cups and then transfer them into the ground when they got large enough. He inquired more about this and then I got him some cups we had used and some good dirt to start them with. I also gave him a few more seeds so he could have multiple foods growing. I could see how happy he was about being able to garden himself (did I mention every time he comes to the clinic he spends a good 30 minutes walking around the garden, he also came and listened to me as I was telling the other patient about the uses of bok choy and chard). This kind of desire to learn and know more about things is just what I was hoping our project would stimulate!