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.