Friday, March 8, 2013

International Women's Day

Blog #4

It is March 8, 2013, International Women's Day. Here in Hinche we have a house full of women.

There are the cooks, Diunny and Salomon, who sing while they work, Elliot the housekeeper whose service and smile encourage us everyday, and Monique who does piles of laundry 2-3 days each week by hand in large plastic basins. I think these women represent what most women in the world are doing each day- trying to provide food and clothing and a clean home for their family. Sadly, it means that the one thing that could bring women empowerment and a way out of poverty for their families- an education-is not available to most women in the world. (Thanks to a midwife donor, at least the 14 year old who babysits for the cook is going to school for the first year of her life and glows when she talks about it.)

Right now I can hear the students from Leogane down in the classroom discussing malnutrition and sources of good food for pregnant women. They watched 2 videos on Nutrition this morning thanks to our projector and a donated laptop. There are two teachers here who have a lot of experience and education behind them who have decided that training other midwives for Haiti is the work they most want to do.

This new class of students are here because we had no clinical site in Leogane, which would have been closer to their homes. Since Monday night they have been sleeping on mattresses on the floor and sharing a bathroom here at headquarters until they can find a place to rent together in Hinche. I am amazed how far they have traveled, how many comforts they have given up, how they are willing to be away from family in order to reach this dream of being a midwife.

It is being around these women that gives me encouragement to continue this work when it all seems so hard. They believe in Midwives For Haiti and its mission passionately and are so proud to be students or graduates of the program. So when I hear another impossible request from the medical director of the hospital, wonder how the budget will get us through the year, and feel exhausted from the constant decisions and responsibilities, I just need to be with them, to hear them sing, to hear them thank Jesus for Midwives For Haiti, and I feel so blessed to know them and to be here.

This afternoon the 16 Hinche students will share case studies from their clinical experiences this past week. The Leogane group will listen in and ask questions. Then for the first time all 24 students will end the week together singing, united in their mission to bring health and life to mothers and babies in Haiti. On this International Women's Day, they know they can change the world.

Saturday, March 2, 2013

There are not enough hours to waste on worry

March 2, 2013

I try not to fret in the middle of the night but it was difficult to find a “letting go” point last night. Tomorrow the teachers and 8 students arrive from Leogane. The logistics of getting them a place to stay, getting mattresses for them, starting classes and coordinating their clinical experiences feels really big. I worry we are going to overstretch our budget and our energy. Some of the restlessness was caused by the events of yesterday when we just crammed too much into one day.

It was one of those non-stop days that left us all in a stupor this morning. The first Friday of the month we always hold Continuing Education classes for all of our graduates that can come. Twenty-seven came in the morning. I had Abby Merryman, OBGyn MD from Dartmouth to help me review partogram use as they are using it very poorly at the hospital even though the hospital administration has done some education on its use.

The most frustrating thing for me about that morning was the realization that although we go to great lengths to have our students think critically about their practices, it is still easier to just do what they are told instead of asking why. So when I asked them why they kept women in bed who had ruptured membranes they did not know except that they were told to do this. Infuriating. Sometimes mornings like this make us feel like failures as educators. I realize this is the challenge of educators everywhere but it seems so much harder in Haiti where everything has been learned by rote memorization and not by thinking through what the research has shown to be best practice.

While the midwives were still here in the morning, seven men arrived from the Church of the Brethren's Haiti Medical team. I had met Dr. Paul Minnich and Jeff Boshart in the fall at a missions conference and they wanted to learn more about what we were doing. They have 3 Haitian doctors that they pay to run clinics in seven areas where they have churches and are looking to expand the services they provide. They have no maternal health component so far. Until I could get free to talk to them, Steve tried to give them information and history on our project while they had cold drinks on the upstairs veranda.

Right after the Continuing Education group left the current students arrived for case study day. Abby stayed to help and observe this and Bobbie Curtis arrived back from matrone training to help also. Students tell of cases they have seen the past week and we all discuss what we can learn from them. This week the cases included a woman who presented at prenatal clinic with extreme fatigue and “poor health” who they sent for some lab work. She had a hemoglobin of 4 (normal is 12-14) and a positive malaria test (a major cause of anemia here.) Her baby measured for small for her gestational age and she received 2 pints of blood and chloroquine.

Another case involved a woman coming to the mobile prenatal clinic in Roysec because she had been told by a doctor near the border of the DR that her baby was too big and would die. Because of her concern, the midwives brought her back to Dr. Celestin at the end of the day for an ultrasound. He found a severely hydrocephalic baby and recommended terminating the pregnancy before the baby's head was too big to deliver vaginally. The baby will die anyway because there is no available surgery for this here in Haiti. (In countries where there are more medical resources these babies would be delivered by C-section at full-term and have shunt put in their head that would enable them to live normal lives.) The woman refused the induction and was advised she must have a C-section if she waits until the head is bigger. Sad stuff for the students to learn.

Once the case studies were over and the students left at 2 pm, I finally had time to have lunch with the Church of the Brethren team and enjoyed hearing about the growth of interest in their project in the denomination that I have been a part of for almost 40 years. They were especially interested in our Matrone Outreach Program and we encouraged them to send someone to our training the trainer program the week of March 18.

Before they left Karen Leichty, CNM turned up to buy some HIV tests and some Albendazole as the medical group from her church in Nebraska that she is working with this week was running low on both. She and a family practice doc had gone to Cabestor with our midwives on Tuesday and she was full of praise for them and our work. She left a contribution for Midwives For Haiti and a promise to come back to volunteer with us.

After the COB group left, multiple graduates wanted to talk to me with various requests. This happens every month. “Could you find a job for me closer to my children?” “I need a new BP cuff.” “Last month I was not here to get the fanny packs you gave out.”

The massive amount of food and drink that goes in and out of our house on a day like yesterday is incredible. Without Carrie and the cooks it would be impossible. By 4 pm I was so very tired when Carrie reminded me it was time for our dance lesson. Let me tell you that living with a 23 year old puts my energy in question. But learning to dance the batacha with our handsome teacher, Fortuna, gave us some good hilarity at the end of a busy day here at “grand central station”.

This morning Gladius helped me with an interview with one of our graduates for a position in the family planning clinic at the hospital. We are receiving a donation of a salary for her. There are still a lot of misconceptions about birth control methods in Haiti – about whether they cause infertility or cancer or make God unhappy. Add that to Haitian men thinking the more babies they have proves their fertility and these poor- and I mean really really poor- women have to be pregnant and risk their lives too many times. Anyway, the graduate has some experience with placing implants and other family planning methods and wants to be able to stay in Hinche with her 2 small daughters so she is thrilled. She is one of those colorful and powerful women who will make it her mission to find every woman who wants birth control and get them to her clinic. While we were waiting for Gladius to translate, I practiced my Creole on her, which caused hearty laughing, and we shared pictures of her girls and my grandchildren.

The truth is that as women we have so much in common no matter our age or nationality. We all want our children to be healthy and happy, in that order. We all want to be loved. We all want meaningful work and the empowerment of an education. That is why we are in Haiti and that is why I did not stay awake long to worry last night. There is peace about our purpose here.