It is 4:45 on Friday afternoon in Hinche, Haiti, and downstairs there is lively music playing as Brittany continues Carrie's tradition of taking dancing lessons. Outside the volunteers are doing a lot of laughing as they take Kreyol lessons from Kenel Pierre. I am trying to recuperate from the busy day by setting on the porch in a rocker, enjoying a cool breeze, and looking at the trees. 

For the end of June, the temperature has not been as hot as I expected and the late afternoon rains cool the air - so sleeping is not a problem- along with the fans, of course.
My Mac says that back in Richmond it is 91 degrees so sitting outside on the deck at home right now would probably not be comfortable.
We are all over-the-moon jubilant because one of our dear translators finally got his visa approved to come to the states with the goal of becoming an OB/Gyn. I called Wendy Dotson, who with her husband, Greg, will host him while he goes to school to give the good news. The meaning of what this opportunity will make for his life is overwhelming and brings me tears to think of it.

It is a time of enormous activity for Midwives For Haiti in Hinche. Right now we have 23 students and hard-working teachers and preceptors. Our mobile clinic midwives care for around 250 women per month in surrounding remote villages. We have an ongoing outreach program for the matrones in the Central Plateau. We continue to support the midwives at the hospital here with salaries continuing education and volunteer work support. They handle around 150-180 births per month and their reputation is high in the community. 

Although it is easy for me to just see the problems, I am continually inspired by the stories of individual women who are blessed and saved by the care they receive from our midwives. There is the baby that is too tiny to eat but getting breastmilk because of a donated breast pump. There is the mother of 6 who would have bled to death if her matrone would have not seen her high number of pregnancies as a risk and insisted she deliver at the hospital. After 4 units of blood she will go home to mother children that would have otherwise had their own survival rate decreased drastically if their mother would have died. 

Ste. Therese is going to have a NICU by the end of September! Ohio State University faculty and staff will be training and supporting the staff over the next few months. Babies who would have otherwise died or been transported to Cange (which is closing their NICU to move the staff to Mirabilais) will be able to be cared for here in Hinche. Monica Trexor, the neonatal nurse clinical specialist, is here with us.

I started today with a problem-solving meeting with our mobile clinic midwives. The to-do list at the end of it includes getting benches made for the clinics where women wait with no chairs, finding a beach-type tent for the clinics that are held outside, and getting a DVD player so that patients can watch educational videos while they wait to be seen. Figuring out snags in the record-keeping and medication orders (getting Cefexime in this country is difficult) and how to pay the announcers in each village were on the agenda also. With the help of Kathryn Kooistra and her friend, Tracy, we are going to have a new way of getting data from our records so that we can measure our effectiveness

The direction of our program for next year weighs heavy on my mind. Our training program needs continual evaluation of its effectiveness. We are faced with probable loss of two teachers to Canada and the U.S.at the end of the year. I think we have the strongest class we have ever had but retaining good teachers remains a problem for us. (Indeed it is a problem throughout the country. The most educated make the most money and are the most likely to leave the country.)

The town of Hinche has been our center of activity for 7 years. But we are asking ourselves if we should continue to teach midwives here at this hospital where there are so many barriers to evidence-based care and in this area where we have saturated the job market for our graduates. It is exciting to have many of our graduates from sponsoring organizations. They automatically have jobs when they finish. The thought of Vilana and Soislia, Mariette and Vesline going to their rural communities and working to bring skilled care where none has been before affirms that we are doing the right thing, the needed thing in training. 

So we ask: Should we teach in another region, should we teach in two other regions if the opportunities are there? (We are exploring Hospital Albert Schweitzer in Des Chappelles and Hospital Convention Baptiste in Quartier Morin.) Should we take only students who are sponsored and have jobs when they are finished? Should we begin to open and support more birth centers? We really believe that the model of birth centers with skilled attendants referring to more advanced medical care when needed is a model that is the most life-saving and most cost effective for every country in this world- including the U.S. How do we incorporate more birth center experience into our students' clinical experience if most of them will work in birth centers when they complete the program?

As always, the path for Midwives For Haiti is never easy or clear. A favorite saying around here is that the problems and questions we face this year will be gone next year but next year we will have new ones. The really cool thing about our volunteers is that they have such good ideas, help us problem-solve and give us encouragement to keep climbing the mountain of obstacles. That's because they are midwives and medical professionals who are earth-shakers.

I am reading "To Repair the World" by Paul Farmer. In a speech he gave to a graduating class of doctors he warned them of the "general anesthesia of the soul" that can come from being among the privileged of this world. For anyone who is experiencing "anesthesia of the soul", joining us in our work here in Haiti will cure you.

Nadene Brunk