A New Chapter for Midwives For Haiti

Arriving in Hinche at sunset

It has been almost 2 years since I retired. It seems longer in many ways because we have done so much traveling with our RV. Because Steve and I are on the Board of Directors - sometimes via Zoom or Skype - we are able to keep up with the organization's major programs.

In the early part of the year the Search committee had interviewed several really good candidates and had chosen Jane Drichta to be the new Executive Director. Jane came to us with multiple qualifications including experience in starting her own NGO, working in the Philippines, Iraq, and Uganda, and having graduate degrees in Global Health and Tropical Nursing. She is also a midwife! She has worked and lived in areas of political instability but she had never been to Haiti. The BOD decided I would be the best person to take her there to introduce her to our staff and acquaint her with all of our programs.

I love taking people to Haiti who have never been before and watching them fall in love with the people and the tropical beauty. And it was especially wonderful for me to see dear friends I had not seen for two years.

 After the long but uneventful trip from Port-au-Prince to Hinche, we arrived at our headquarters in the early evening. The house looked so good! The downstairs rooms had all recently been painted in the pale mint green and everything looked so fresh and clean. Jane was thrilled with the house and with meeting all of the people who work for us there.

Sunday afternoon food and staff arrived for the First Annual Staff Appreciation party. Speeches were made and included a reminder from the head of nursing at Ste. Therese hospital to Jane - without Midwives For Haiti there would be no maternity unit at that hospital and many lives would be lost. There was singing. My favorite part of every party in Haiti is the singing!

The new class, Class 11, began on Monday. It is always exciting to meet these nurses who have been chosen from over 180 applicants to begin to become midwives. I shed a few tears as they gathered and started their day with a hymn of gratitude and introductions to all of us and all of them.

The classroom ready for Monday morning.

Students arriving at the gate

Daisy and Perrine registering the new students.

Class 11 at the beginning of an 18 month program. Lead instructors are Limone Clerveau and Daisy Grochowski.

Jane and I had other work to be done. We had a typically long wait at the bank to get the MFH account set up for Jane's use, a meeting with the staff, a review of volunteer handbooks that had somehow been lost since I had left, and went through supplies.

In the past year we had transitioned from the mobile clinics going once a month to 22 villages to placing midwives in government owned clinics on a weekly basis in 8 of the villages we had visited before. This increased the quality of care we are able to give because we can follow women more closely who need vigilance on blood pressure medicine or in other high risk circumstances. It also was welcomed by the government and as they had only one nurse at each site who did not have the skills to do prenatal care and risk screening, they were thrilled to give us a room in each clinic for that purpose.

I went to La Belone to see how the prenatal clinic works there. I enjoyed seeing the countryside on the way out. I also enjoyed talking to the pregnant women as they waited to be seen. They were all grateful for the midwives and some had walked 2-3 hours that morning to get there. They just wished there was a midwife there full-time so they could have skilled care during their deliveries. Sadly, until we get a midwife in every village, most women in Haiti still deliver at home without the skilled care they should have.

The road to La Belone

I borrowed Midwife tools for clinic.

The clinic at La Belone

Beautiful Haiti countryside

 A walk to our praying hill, an evening of heavy rain, a visit to the grocery store, and lots of long talks over our cold beers on the porch rounded out Jane's first week in Haiti. One day I made bread and ice cream. 

Making ice cream is a team effort. The 2 gallon recipe included the yolks of 15 eggs, expensive cream I had brought from Port-au-Prince, milk, raw sugar, and 7 bananas. Davide got a large rectangle piece of ice from the market. It's about 2 foot long and a foot square. Then he puts it in a bag and bangs it on the cement outside to get it into pieces small enough to fit in the White Mountain freezer around the canister of ice cream. Chunky rock salt is added to the ice and then Toro and Davide churned until it was too hard to churn. I told them how my dad would fold up a rug and put it on top for me to sit on so he could crank it harder without moving the churn. 

Breaking up the ice block

The cooks and the men got the first bread out of the oven and the first rounds of ice cream. They were very happy and I enjoyed my time working with them.

Cranking ice cream

Magdala and husband, Pastor Jude came to visit me

At the beginning of the next week, the protests about Petro Caribe were starting again. I needed to get to PAP to catch a flight on Wednesday but left a day early hoping to miss some road blocks. But near Mirabilais our vehicle sat in a long, long line of vehicles- perhaps 2 miles long, and waited for an hour or more for the road to clear. Police had to come and get the protesters to move the barricades of trucks and tires. Only one lane could go through at a time so we were happy our lane got to go first.

I never felt unsafe. However, the protests have become more violent since August. There seems to be no end in sight and I fear Haiti is headed to a huge humanitarian crisis. Without fuel and with unsafe roads, doctors are not going to work at the hospitals. Without fuel, trucks and cars cannot deliver food and goods. Our birth center manager was robbed. A student was hit in the face with a rock. At one NGO, that runs a birth center, a needed C-section did not happen when it should have and the baby died. People are starving and people will die in record numbers unless there is international intervention. 

We are no longer allowing volunteers to go to Haiti. That means the sutures, the IV tubing, the dressings, the gloves, the baby clothing and blankets, etc, are no longer coming down. It makes life very difficult in the hospital for our teachers and preceptors.  MFH is going to try to use American Cargo to ship supplies that are being donated to our Richmond office via Amazon.  The first shipment goes this Friday with a lot of prayers it is not stolen and that our staff stays safe while picking it up. 

People ask me since I am back, "How did it feel to be in Haiti and not be the Executive Director anymore?" My answer is "It was wonderful to feel the love and pride about the program's accomplishments without the burden of keeping up with all of the obstacles and problems that are inevitable working in Haiti. It was also good to see my dear friends in Haiti. But I am very thankful for Jane and to have capable staff and leadership to carry Midwives For Haiti forward to places I could not go." I am very happy to be retired. And again- grateful beyond measure for the people continuing to work to save the mothers and babies of Haiti!

Me with Mario Cleophat, Midwives For Haiti Program and Partnership Manager

I end with this quote from Leila Janah:

At the end of our visit, I watched a woman deliver on a squalid table with a gruesome expression and thought about my friends giving birth back home in beautiful facilities. How is it that such a grave disparity persists in 2019, with all the wealth in the world? Why do we allow some women to suffer so needlessly because they happen to live in a country without the resources to care for them properly? This isn't a Ugandan problem, or an African problem or even a women's problem. It's our problem. Every woman that dies or loses her baby on a threadbare cot in the heart of Uganda, in a shack in Haiti, while her sisters on the other side of the world enjoy first-class care, is a threat to our collective humanity. Italics are my additions.

Abortion- What's Love Got to do with it?

Photo by B.D. Colen

I want to talk about abortion in Haiti. But first here are two true stories.

In my practice in Richmond, I saw the midwifery patients most of their pregnancy visits, referring them to and consulting with a physician for anything that was not normal or was concerning. Because of this, I got to know my patients quite well and could not help but deeply care about their lives and what the new baby and birth would mean for them.

One day one of my patients arrived for a routine visit and had an unusually high blood pressure and 4+ protein in her urine. Christy looked completely normal and had no other symptoms except perhaps a mild headache. But these are cardinal signs of preeclampsia, a killer of women all over the world as it can lead to kidney failure, brain swelling that leads to seizures, and death. No one knows what causes preeclampsia. There are some things that can be done to treat the symptoms but inevitably the only cure is to end the pregnancy.  This is upsetting to the woman, frightening news to get, but in this case it was especially frightening because she was only 28 weeks pregnant and ending the pregnancy now meant her baby's life was at risk. The hospital where I worked did not have the necessary equipment and the experts to keep a baby alive who was less than 32 weeks gestation so she was sent to another hospital where the baby could get the necessary help if needed. 

I went home that afternoon hoping that Christy would be able to get steroid injections over a 24 hour period that would help her baby's lungs mature and give it a better chance of survival. The next morning I learned that when Christy arrived at the hospital her lab worked showed that she was in critical condition, could have a stroke or seizure at any time, and her kidneys were barely putting out any urine. An emergency C-section was performed and the baby went to the Level 3 nursery immediately. Christy rapidly started to get better. Her baby received the very best of care possible for babies who are premature and even though she had not had time to get the steroid injections they were able to help her baby breathe until she was able to do it on her own weeks later.  Christy and that baby are still alive today.

Here is a similar story in Haiti. Josette was a midwife trained by Midwives For Haiti who worked full-time at the hospital in Hinche. I had barely arrived in Hinche on a Saturday afternoon when I was told that she wanted to see me. I went out onto the porch to meet her and found her barely recognizable. Her face and hands and feet were very swollen. She was obviously pregnant. 

Josette came with a note from one of the Haitian obstetricians saying that she needed to be on bedrest because her blood pressure was high and she had protein in her urine. She wanted me to know why she would not be at work the following week. When I saw the note, saw her lab results, and saw her, I was scared for her but when I heard that she was only 27-28 weeks along in her pregnancy, I was aghast. Nowhere in Haiti does a baby of that age have a good chance of making it if born that early.  She assured me she would go on bedrest, drink plenty of water,  and pay attention to signs of increasing problems like not urinating very much, headache or confusion. She also assured me that another midwife who lived near her would take her blood pressure twice a day.

Josette knew she was in grave danger. Over the years of working at St. Therese she has seen a lot of death of both mothers and babies. She had fought for their lives. She knew she could die, too. Stupidly, I asked Josette if she knew that most likely the baby would need to be born soon. Of course, she knew. We hugged and prayed. I wanted to keep tabs on her so we made sure we had her phone number before she went home to bed. 

But the very next day, she was put in the hospital because her blood pressure was in stroke range. That was Sunday. We do have betamethasone in Haiti which can help mature the baby's lungs so Josette got 2 injections 12 hours apart as prescribed. We needed time. Every day that baby could stay in there the better its chances were at survival. She also started getting Labetalol, a drug that would help keep her blood pressure under control.

Monday night we were so concerned that we were standing by her bedside and Dr. Eads was giving her boluses of Lebetalol in her IV, retaking her blood pressure, giving her more and more and the blood pressure would not come down. We were very fearful she would start having seizures or have a stroke. So late at night we left her in the the hands of another midwife with strict instructions on keeping her dosed throughout the night. We drove to where the Haitian doctor lived, got him out of bed and had a discussion outside beside our vehicle about what he planned to do about Josette. 

This doctor had worked with Josette for years and cared a great deal that she have a good outcome for her pregnancy. He was scared about what would happen to Josette if we did not end the pregnancy and he was scared about what would happen to the baby if we did end the pregnancy. The two doctors agreed to give her that night at least and confer in the morning about what to do. The next morning, Josette was sluggish and her blood pressure was 180/120 even with medications. She was in grave danger. The doctor was very busy and did not do the C-Section until late afternoon. Josette did fine with the C-section and immediately started to get better. 

But her baby did not have a Level 3 nursery and the staff did not have the equipment or training to save a baby that young and the baby died very soon after birth. We were all heartbroken. But we knew the C-section had saved Josette's life. Today, Josette is alive and well and takes good care of the one other child she had before this pregnancy.

What do these two stories have to do with abortion? They point to the fact that every day doctors are making life and death decisions for their pregnant patients that have enormous consequences and that sometimes means they have to choose between one life or another.  The choice is one life or two deaths.

I think of these two stories when I think how ignorant most people are about pregnancy, birth, and why there is a mother dying every two minutes across the world from complications of pregnancy. Because of what I have witnessed in Haiti, I am keenly aware that birth control saves lives, that a lot of sex happens without consent, that in many places women's lives are cheap, that where you were born and who you have around you can determine whether you will live or die before, during, or after pregnancy.

Abortion is illegal in Haiti. I think it would be hard to find any medical professional willing to perform the procedure. But abortion happens frequently in Haiti- probably daily- because I know one hospital that sees the aftermath several times a week. There is a medication that people can buy on the black market (on the street) anywhere in Haiti that induces abortion at any time during a pregnancy. Legally buying that drug in Haiti at a drugstore is very difficult.

(This causes problems for organizations like Midwives For Haiti and other health care organizations who want to use it exclusively for treatment of post-partum hemorrhage (PPH). Postpartum hemorrhage is the second most frequent killer of pregnant women in Haiti and is number one in many countries in Africa and Asia. It is no discriminator based on religion, race, or wealth.)

I remember one 13 year-old brought in by her father for pain and bleeding following an induced abortion by this medication. My student and I found the dead baby, estimated to be about 18-20 weeks gestational age, between her legs, still in the amniotic sac and still attached to its cord.  I wondered if her father gave her the medication or if he was the father of the baby. Within an hour after we had removed the placenta he walked her home, refusing any birth control method.

I remember a mentally impaired woman brought in by her sister.  The midwives said she comes in every year or so with an induced abortion because the men in her village use her for sex all the time. We spent weeks trying to figure out a place for her to go besides back to her village. Because of the lack of any social services in Haiti we struggled to find a safe place for a grown woman with mental impairment. Then one day she and her sister disappeared. With an IUD in place she would not get pregnant again but I still think of the hell her life must be.

For women in Haiti there are terrible things that make them consider abortion.  The inability to feed themselves or the children they already have, the loss of financial support from the father or from family, rape and abuse. They feel there is no other option. And sometimes when we see the 80+ children in the feeding center with their distended bellies and no energy to even feed themselves we get a hint as to why women in Haiti choose abortion. Watching your child die slowly from lack of food is a terrible thing.

So what do women in Haiti need in order to stop abortion from happening? It isn’t religion because faith is strong in Haiti.  Women call on Jesus daily for food for their children, to be delivered from sexual abuse, to escape their terrible lives. They are calling “Jesu, Jesu” as we deliver their babies, dead or alive and we are trying to be Christ-like to them. What we are unable to give them is food for their families, years of consistent birth control, and locks and security in their homes. Living in a mud house or a house made of tarps is invitation to sexual abuse. If we had all these things to give them, plus easy adoption to loving homes (finding “loving” is part of why it is not “easy”) there would be no abortions in Haiti.

Unplanned and unwanted pregnancies occur even with the best birth control. However, the abortion rate in the USA dropped 25% after the Affordable Care Act  (CDC records), largely due to increased access to birth control.   It dropped 40% in Colorado when birth control became totally free. Now we are facing repeal of the Affordable Care Act in exchange for one that considers a pregnancy or a previous C-section a pre-existing condition that insurance companies can choose not to cover.

I have heard people say things like, “She shouldn’t have more children until she can take care of the ones she’s got” and “She shouldn’t have sex if she can’t afford birth control”.  This ignores that sex often happens without choice for a large number of women. And it ignores that even women who are in loving supportive relationships have unplanned pregnancies. I am one of the millions of women who had an unplanned pregnancy. But it was not unwanted because I knew I could gladly care for and love another child. And I had everything that most Haitian women do not have. 

Haiti proves that laws outlawing abortion do not end abortion. There IS logic to giving women love, support, food, shelter, birth control, and medical insurance. I love my granddaughters so much and hope they never feel so desperate they even think about an abortion.  But if all abortions are outlawed they will be afraid to enter the hospital with life-threatening bleeding for miscarriages and ectopics and the doctors will be afraid to treat them for fear of being investigated for causing the bleeding. I fear for my granddaughters when or if they have a miscarriage (1 in 4 pregnancies end that way) or if they have an ectopic pregnancy that has to be removed to save their lives. Will they be put in jail, will their doctors be put in jail, will all their medical records get scrutinized by lawyers who do not even know what an ectopic pregnancy is or how to treat it? 

I think pro-life and pro-choice Americans should sit together and figure out how to decrease abortions in this country. Because women and mothers are valuable. Because love has everything to do with it.