February 9, 2013

Several people have said, “Blog, Nadene. You should write about your life here in Haiti.”

Perhaps today I can start. It's Saturday and a little more relaxed although the “to do now” list remains impossible.

Yoga with Carrie, iced coffee and a last breakfast with Marion Alex, CNM from Nova Scotia, washing my clothes by hand and hanging them in the sun. Checking to make sure Renald's abscess on his face is getting better with antibiotics. This is my morning.

This past week we went to Leogane again to meet with Dr. Charles and Rotary president and past president- our second visit in a month. They are all so eager to see us start our classes there at the CAMEJO campus but we are not certain how to proceed without causing increased difficulty with a partner in the U.S. who is very much against us using the CAMEJO building. It is on Dr. Charles' property. Dr. Charles says it is for midwifery training and rent-free for the first year. It needs some plumbing and electrical wiring completed before the teachers can move in and we are willing to pay the $1000 it would take for Fanfan, the technician, to complete the work.  This person in the U.S. wants us to pay $1100 for the use of the classroom and $50/night for use of the 2 bedrooms for the teachers- a total of $2600/month for use of “his” building. This is not in our budget for training midwives at Leogane. 

Part of his antagonism stems from a misunderstanding about what kind of midwives we train. He thought we had agreed to train midwives who would “go back to their communities to work, not stay in hospitals to work”. It is true that our long term goal is to get skilled midwives out into the rural communities. What he did not understand is what a “skilled birth attendant” is and what it takes for her/him to practice as a skilled birth attendant when she/he has completed our program. Without IV's, medications, clean birth tools, ambu bags, the ability to sterilize, one cannot practice as a skilled birth attendant no matter how good your education has been. Without a salary and an ongoing supply chain it is not possible to put skilled midwives in rural communities. They will not have the means to establish themselves and keep a sustainable practice in a mountain community without some outside support.

The Rotary Club in Leogane understands what we do and why very well. In the Central Plateau we have accomplished this by connections with NGO's who want to hire skilled birth attendants and place them in rural communities. An example is the birth center at Thomassique supported by Medical Missionaries. One hour from the nearest hospital three of our graduates provide skilled care to hundreds of rural women each month. They deliver 35-40 babies each month, give prenatal care, educational classes and have an outreach program to local matrones so that more women at risk are referred to them appropriately. There are more of those examples across the country.

It is true that we have fourteen of our graduates working at the hospital here in Hinche. But with more and more communities sending very sick women and women at risk to Ste. Therese they are absolutely necessary. The third leg of saving lives – a well-staffed and equipped tertiary center- did not exist five years ago. When we began our program in Hinche in the fall of 2006 no skilled care givers could be found in the maternity unit most hours of any day. Only occasionally was a Cuban doctor there. Women avoided coming unless they were desperate and sometimes the housekeeper was the only one there to catch their babies. Maternal and fetal death happened there EVERY WEEK!!! No wonder no one wanted to come.

The picture has changed at Ste. Therese because women will come if they know they will get compassionate and skilled care. In Leogane they flood to the Doctors Without Borders hospital there to receive skilled care. But what will happen when they leave in one year? Women will go back to delivering at home unless there are skilled caregivers readily available at small birth centers and clinics in the surrounding communities. That is what we want to do- start training now for immense need for skilled birth attendants in Leogane.

Meanwhile in Hinche, seventeen new students have completed 4 weeks of training. We are continually improving exams, training teachers, and adding French and Creole resources. The day-to-day problem-solving on the logistics of precepting 17 students in labor and delivery, prenatal clinic, matrone outreach, mobile clinic, antepartum and postpartum and post-op units is a daily challenge. But this is what gives me the greatest joy- to see the learning happen, the lights go on, the self-confidence grow. 

I do not know what the next week brings for our plans in Leogane. We live by faith from one day to the next. The obstacles seem sometimes insurmountable. Next week we will not have the same problems- just new ones. Too many lives are at stake to give up.

The mobile clinic had an eventful week- unbelievable stories. But that is another blog for another day.