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.
