Vaginal Breech

I arrived at Diquini Adventist Hospital for my last day in Haiti, this past Saturday. I knew the 3 midwives that I enjoyed working with would not be there, as it was their day off. Instead I found 2 young American OBs. Since it was their first day and they were getting acclimated to where things were, I was able to give them a quick orientation to where things were located. (I had helped one of the midwives organize the supplies a few days before- so glad we did that.) The maternity unit is located in a separate building from the main hospital. It is just adjacent to the hospital in a little one story building that houses pediatrics, maternity, and the GYN clinic. A cloth curtain separates the pediatric section from the maternity section. To reach the GYN clinic, we have to exit the building and walk around to the other side. There is much construction going on that separates the two ends of the building. The GYN clinic is basically done on the 'back porch' of the building. The maternity clinic has a 4 bed 'ward' with 4 more beds added in the hallway for a total of 8 beds. One of the OBs has a great idea to number the beds and locate all the charts for each patient. Simple as it sounds, this has not been done. I set to work making signs from masking tape and markers. I locate current patient charts stacked on the nurse's desk. We file away the patients that are no longer there, and place signs on the charts denoting which bed each patient is in. Now that we are organized (somewhat) we can better manage our care. Miraculously, the Haitian nurse assigned to this unit, seems to know all her patients, where to find their charts, and is very on top of the patients assessment and medication regimens. She carries on with her duties quite oblivious to us, and seems more annoyed than amused by our attempts at 'organization.' I decide not to give any medications because I'm afraid they'll be given twice, as she has not missed a dosage for any patient. Instead I assess new patients coming in who think they might be in labor. As usual it is a busy day. I set up for deliveries in the delivery room. Our delivery room, and the three surgical suites in the hospital are the only air conditioned rooms to be found in the hospital. As result, we get lots of staff wanting to 'visit' us. But its nice to meet and talk with folks when we have the time. Today the pediatric unit is staffed with ER nurses that came from Quisqueya with me this morning. We had a group of about 14 providers come to Diquini today- a huge group, including several physicians who will be kept busy all day in surgeries. There is never an inactive moment on the maternity unit. I do labor checks on the pregnant women, and postpartum checks on the recovering mothers. I make sure babies are getting on the breast, bleeding is under control, and that vital signs are normal. I chat with the two OBs who are adjusting themselves to the circumstances. One OB orders pain medication for a laboring patient. I assure her I have seen no such meds and that all labors are unmedicated. The other OB goes over to the hospital and brings back one small vial of nubain (1 vial!) It was all he could find. We treat it like gold. At one point, early in the day, the two OBs go over to the hospital to scout out the facilities, while I hold down the fort. While they are gone, one of the ER docs (whom I met at Quisqueya this morning on the truck) comes running in to tell me that a woman just arrived in the ER on the back of a truck in obvious labor. They didn't even get her out of the truck, they are just driving her right over. Do we have a stretcher to bring her in? Well, of course we don't, but no worry, a minute later she comes walking in between two of her relatives, and get on the delivery table (which is really just a rickety old GYN examining table without the stirrups attached.) I shoo everyone out so I can check her, one of the ER nurses from pediatrics stays to help me. I do a vaginal exam to check for dilation (she does appear in great discomfort) and the following thought pops into my head: "What the fuck is that?" I'm feeling something that I have never felt before after doing hundreds of these exams. It was bony and angular and I could not find cervix no matter where I "looked" (ie. touched). I'm not entirely sure what I'm feeling, but I know it is not a head. Besides that, mom was making pushing sounds. I check for cord, but do not feel that either (thank goodness). It occurs to me that I have never felt and actual breech presentation before, because in the US these patients are scheduled for cesareans before they start labor, typically. I withdraw my hand and attempt to find heart tones. Not sure of what exactly I felt, I placed the doppler at the base of her belly, and find heart tones of 110s. At this point the ER doc comes back in, and I relate to him my heart tone and exam findings. Did you check mom's heart rate, he asks. Great question. I get my stethoscope and get an apical pulse of 90s. What I heard on mom's lower belly could have been her. I had placed the fetoscope on her upper belly earlier and couldn't find heart tones. The ER Doc picks up the doppler and finds heart tones on her upper belly in the 130s on the first attempt (shoulda used my Leopold's!). We say simultaneously, 'breech'. Where are my OBs? The ER guy asks, Do you think they'll want to do a cesarean? I said, I'm sure they will. It just so happens I overheard a conversation they had with one another earlier about breeches. One asked the other if they had ever done vaginal breeches, and the other answers they had done 3 or 4 but that they would rather not. ER Guy leaves to scope out the possibility of a surgical suite for a cesarean. I get vitals on the woman and hope the OBs show up soon. I still don't know if she's complete or if I just can't feel the cervix, but I do know she is pushy. If there's going to be a cesarean I'll have to start an IV and foley. Just then, they return, I explain what's going on. (There's been a lot of commotion in the hallway with relatives, ER staff, interpreters, and pediatric staff). They both want to do a cesarean, but when the male OB checks her again, he says, it's too late. The pediatric nurses rush in and set up the warmer (newly arrived and circa 1980s) for infant resuscitation. They spend the entire delivery trying to figure out if and how the thing works, and getting the oxygen going (bless their hearts, they were working really hard with such limited supplies- they kept bringing in supplies from their area when they couldn't find them in ours). The male OB preps for delivery, sending me on a frantic search for a gown. (The midwives didn't bother, but both OBs insisted on being properly covered for deliveries.) I found one, helped him get it on and gloved and the patient is still pushing. We get her into pushing position (I hold one leg, the other OB holds the other) and on the first push like that, out pops a little leg. A couple pushes later, we get the other leg, and the OB delivers the baby to the armpits and wraps a blanket around the body (baby blankets are hard to come by around here, its really just a square piece a fabric we found). Next the OB doing the delivery (the male OB) reaches in to manipulate the arms out. With that done, the baby is out except for the head. We expect baby to be born any minute, but that is not what happens. It takes at least a full 10 minutes of manipulation, praying (The OB doing the delivery was praying audibly right next to me as he worked frantically to get the baby out. At one point the ER doc returned to report back about the availability of an OR. There are no phones, no intercom system, no pagers, nothing. The only way to communicate with another part of the hospital is to send out runners. That's why folks just walk back and forth when they want to find something out. So the ER doc comes back to say that there won't be an ER available for at least 30 more minutes. (Either its still in use or being cleaned.) The OB had just a few minutes before mentioned again the possibility of a cesarean and pushing the baby back up,but now without that as an option, he redoubled his efforts at manipulating the stuck head. I remember shouting to the ER nurses where things were located as they frantically tried to put their supplies together while I held on to mom's leg, tried to comfort and reassure her (in a foreign language!) and instructing our interpreter to glove up and hand the OB whatever he asked for. The other OB offered to do fundal pressure. Not sure about the merits of fundal pressure, I offered to apply suprapubic pressure. He said okay to both. We both applied pressure, the OB on the top of the fundus, and me with a fist right above the pubic bone, with mom's pushing. This made a little progress, then, with time quickly ticking by, the OB handed the wrapped baby to me (limp and blue in my hands) and cut an episiotomy and with a little more manipulation, baby's head finally came, followed immediately by the placenta. (more on that in a minute). We were all holding our breaths and praying. We all thought the same thing, this poor baby probably won't make it. He quickly clamped the cord and passed baby off the the waiting team of nurses at the warmer, two ER nurses and a family nurse practitioner leading the team. (Not a NICU nurse in the bunch!) I quickly turned my attention to mom as the OB and I worked to control her bleeding. I gave her pitocin IM and then set up supplies and lidocaine for a repair. I had the interpreter scrub into the sterile field and hand instruments to the doc because I ran between mom and the baby fetching supplies and equipment for both teams. Several minutes into the repair, we heard a baby start crying! Incredible. Surely this baby was snatched back from the jaws of death. I was amazed that our hodge podge team with our pieced together supplies and equipment had been effective. Even the OB was startled to hear the baby crying, and looked up from his repair with surprise and relief. Later as we all tried to piece together the delivery summary with the correct times (keeping track of the time everything occurred was actually MY job as the delivery nurse, but I had not looked at the clock even once during the entire ordeal) we mused about the placenta. It was worrisome, because we had no way of knowing how long that placenta was dislodged prior to the baby being born. It appeared to already be right there after the head was born. There was some risk of hypoxic injury to the baby, but we could ony speculate. The female OB thought there might have been an placental abruption, but I still wonder if fundal pressure might have had a role in dislodging the placenta prematurely. After mom and baby were stabilized, they were placed in a bed and left to breastfeed. We went on to another delivery.

Last Day

Today is our final day at Quisqueya. Even though it has only been a week, I have made family. Grace the neurologist, Junith, the Hatian American OB, Matt and Emma, Ki Ki my interpreter, Kathleen, Lorraine and Dee the midwives at Diquini, Shawn the videographer, Wendy, our roommate, Art and Miquette, our hosts, Bly, Robert, Morio, Roodly, Alex and several other young Hatian interpreters, Dan our driver (and Miquette's brother). I have made friends and some family. It has been good. I am content to go home, but I am blessed to have come. I will miss Ki Ki, he is my Haitian son, and the hope of Haiti. I got word this morning that the 31 week baby survived the night. Yet another miracle in Haiti. It has indeed been a week of miracles. We fly to Ft. Lauderdale this morning and back to KC Monday morning. I'm hoping for a much needed massage and manicure once I hit the states. A walk on the beach might be in order as well. Yes there are beaches here in Haiti, but the once we had access to were polluted. I look forward to blogging more in depth over the next few days about my experiences. Stay tuned...

Diquini III

Had an awesome day at Diquini (pronounced de ken ny). Arrived to find my 3 lovely American midwives away on a day at the beach, and the maternity unit staffed by 2 young American OBs (one African American, the other Haitian American). We had a very eventful day together that included a vaginal breech with infant resuscitation, a first time mom with a postpartum hemorrhage, and a preeclamptic mom with out of control blood pressures who needed an emergency cesarean (at 31 weeks!) None of the other hospitals or even the Red Cross tent hospital would take her because you really need a NICU for any hope for a 31 week baby. Diquini doesn't even have an incubator. But since skyrocketing blood pressure can lead to seizures and death for the mother they elected to go ahead. I helped take mom to the ER and then had to leave for the day. I'll never know how things turned out, but I can guess...
My time at Diquini was my absolute favorite. I loved going to that hospital. Because I had been there two other days, and had helped one of the midwives organize all the supplies, I could really help the OBs find what they needed. I knew immediately if they asked for something, if we had it or not (mostly not). They wanted to medicate the laboring mothers, but I told them there were none of those medications, everyone delivered naturally. They were astonished. They then let me take the lead in laboring the moms and managing the flow of patients. It was fantastic. We really worked as a team, and they were very humble in the face of such a drastically different work environment. I told them I had homebirths and was comfortable managing natural labors and they seemed to breathe a sigh of relief. I got to say goodbye to my beloved midwives, I ran into them returning from the beach. I so appreciated my experience with them and the OBs, and my time at Diquini. I hope to someday return to Diquini.

Haiti Family Mission

I feel badly that I haven't got to post like I really want to. The internet connection has not been good, and my time to post has been very limited. My days have been long and eventful and I have so much to tell. Once I get back in the states tomorrow, I will go back and review everyday. Yesterday we were assigned to Haiti Family Mission, which was an outdoor clinic (not even a tarp this time, we were under an almond tree). It was another busy day of seeing women and babies (they were specifically assigned to me- no men). I treated lots of yeast infections, bacterial vaginosis, and bladder infections. Even though I was given a private space to do exams, I got very good at diagnosing by getting the patient to describe their symptoms, so I didn't have to examine them on the hard ground. White lumpy discharge? yeast infection, yellowish discharge with fishy odor? bacterial vaginosis, greenish frothy discharge? trichomonas. I knew my vast knowledge of vaginal discharges would come in handy some day! My saddest case was having to explain to a young lady that that 'bump' in her vagina was herpes. When I asked the interpreter to ask if she currently had any sexual partners, she said she " had a man back at the house". For the rest of the day we all joked, that we had a 'man back at the house'. After returning to Quisqueya (pronounced "kisskaya" by the way) I finally gave a call to my 'man back at the house." It was good to hear his voice.

Diquini II

Well apparently, Quisqueya crisis center is in the 'good' part of town. Yesterday, when I was assigned to Diquini Hospital, we were driven for an hour and a half through some of the worst urban landscape imagineable. As we neared the 'downtown' area of the city, we saw the worst destruction, and people just lived on top of the rubble. Its difficult to put into words how I saw people living. Piles of rubble everywhere. Sewage filled canals. People living in shanties in the middle of the street. Tents pitched right on sidewalks and in every spare corner. There were thousands of people EVERYWHERE. So many people. The dust from the gravel roads, or burning garbage, or both forced us to wear masks during the long bumpy ride there and back. At Diquini I found 3 American midwives who welcomed me warmly. The rest of my team was assigned to the very busy ER and OR. The maternity unit was a separate small building adjacent to the hospital. The building held the 4 bed maternity unit, a gyn clinic, a pediatric unit, and a tiny room devoted to the NICU.

Diquini

I have so so little time to write. Yesterday morning I couldn't get my computer to work, and last night we returned to the compound very late after dark- no internet connection. It has been very eventful, but no time to write. Yesterday and today I go to Diquini Hospital, the smallest of the three hospitals we are being sent to. I spent yesterday with an American midwife, running the maternity ward. Assisted with two births. Will return today. The need is so great. Saw the presidential palace, crumbled in on itself. Looked much worse than on tv. So crowded, so poluted, so many people, so few resources. Have to go, will try to write tonight if we don't get back too late...

Jungle Medicine

Just returned from practicing true guerilla medicine/nursing. None of the luxuries of yesterday. Gone was the cool comfortable ( not air conditioned)church building with a separate building for waiting patients. Today we were sent to another tent city. Our 'clinic' was under a tarp and our pharmacy inside a parked tap-tap. We saw many more patients with totally different problems. Our open air tarp covered clinic was hot and dusty and crowded. Internet went out, will have to finish this post at a later time.

Morning in the Compound

Another warm and beautiful morning in paradise. It truly is beautiful here. Port au Prince is ringed by mountains on three sides which you can see in a distance from any direction. The foliage is lush and abundant. The people are beautiful too. Handsome and strong, the Hatian people have the best posture! It comes from the large loads they carry one their heads. They are fine boned and short statured but lanky.
It is busy in the compound as everyone prepares for their day out in the city. A small army of interpreters sit under shade trees waiting to be assigned to various groups. Drives gas up their vans and tap-taps from the compound gas tank. Physicians and nurses visit the on-site pharmacy to stock up on needed medications for the day. I consulted with family doc this morning. That illness that was 'going around' that I saw in every baby yesterday was Typhoid Fever. The good doc gave me some great treatment ideas and I was glad we were on the right track yesterday, when we didn't even know what disease we were treating. Very high fevers and diarrhea are the hallmark signs. I did some reading up on the disease process. Most times it will run its course, but for children who are already compromised, the dehydration can send them on a downward spiral. The little girl I saw yesterday was very bad off. She needed IV hydration or she might succumb to the disease before it ran its course. I also saw a 14 year old who was the size of an 8 year old. Chronic malnutrition is to blame. With any hope if he gets better nutrition he can recoup some of that growth during puberty.
Today we are being sent to a different tent city. We will have a different driver, but hopefully the same interpreters. I am quite smitten with KiKi. the is a beautiful and bright young man with a quick sense of humor. He is also quiet and wise and reminds me of my 21 year old. William would have loved meeting KiKi, I'm sure of it. I can hardly wait for the adventures the day holds. I'm trying to post pictues of some of the sites. The city is in disarray, but the school compound is our little paradise. I'm meeting and working with wonderful individuals. A group of school girls cross the campus. I forget that the school is still in operation. All the classes take place in the chapel, in the far corner of the campus. The relief organization has taken over every other area of the campus. There is so much work to be done. Every evening, Mequette (the Haitian school nurse and assignment organizer) begs for volunteers to work the night shift at the locals hospitals. Mequette spends all day on the phones, communicating with hospitals and clinics all over the city and outlying areas. She is the one who assigns where everyone goes and with whom. Art (an American phys ed teacher who has taught at the school for two years) it the camp organizer. He and Mequette bring amazing organization to a place that has new people arriving daily. I have met people who will be here as little as a week, and who have been here for months. There are about 60-80 relief workers at any given time, not counting the military who reside on the other side of the soccer fields. Sadly, I am only one of two African-Americans I have seen here. But of course, I am grateful for whoever comes. Matt, my team leader, is meeting with our driver for today. It's time to grab my suitcase of supplies and hit the road. I do not know what to expect in the new location. It probably won't be as nice as the church yesterday. We also lost YeVonne, our most experience relief worker. She was assigned to another group, and we got a homecare nurse who just arrived yesterday. I guess that makes me the veteran. I'll be showing her the ropes. Thank you for your continued prayers. I'm having the time of my life.

Bonsoir

We had a fantastic first day. Our team consisted of a physician, two nurses, a pharmacy tech, a team leader, 3 Haitian translators, 1 Hatian driver, and an American documentary maker. Our translators were adorable. They were all 21-24 years old and translater for us throughout the day. There was one translator for every healthcare provider. My translator was Ki-Ki. I could have pinched his cheeks he was so adorable and reminded me of my own 21 year old. We started the day with a death-defying 40 minute drive to the slums of Port au Prince. There is nothing quite clearly defined as a 'lane' on the Haitian rodeways. There was some paved road, but a lot of the side streets could only loosely be termed 'streets'. There are no such thing as 'speed limits', you go as fast as you possibly can given the circumstances. Not only do you have to avoid the other vehicles, there are all the people (no distinction between sidewalk and street), and livestock, such as hogs, chickens, goats, sows. Having arrived safely (barely) we set up our clinic in a church. The pastor greeted us warmly and had a small army of helpers to assist us in any way. We unpacked our two large suitcases of medicines and supplies. We set up a makeshift pharmacy on the alter, manned by the pharmacy tech and the team leader. The physician and us two nurses each had a small table with three chairs, one for us, one for the patient, and one for the interpreter. There was a draped pulled across one room with a bed behind it for examining patients in private. The three of us each saw patients simulataneously, stopping to ask the other questions if we needed a 'consult'. I asked the physician to give an opinion on an umbilical hernia, and was asked by the physician to do a pelvic exam on a young woman. The cardiac nurse asked me to assist her with a breast exam. Otherwise, we all assessed, diagnosed, and treated our own patients. Between the three of us we saw 106 patients. I saw many babies, almost all of whom were suffering from fevers and diarrhea (a deadly combination in such a hot climate). We treated them with antibiotics, except one that had a temp so high (104) and was so lethargic she couldn't keep anything down. We told her family to take her to the hospital immediately. In the adults we saw, fungal infections, headaches, body aches, back pain, various infections. I also saw what I thought was a possible abdominal aortic aneurism, a potentially life threatening disorder. She came in insisting she was pregnant (at age 52) because her belly was getting bigger. Sure enough, a pulsing mass could be felt in her abdomen proximal to her umbilicus. We insisted she go to the hospital immediately, but she probably won't. After we saw every patient, we held hands with the pastor and his team, sang songs, and prayed and then packed up the pick up truck and made another death defying ride 'home'. I'm looking forward to my dinner of beans and rice, and a walk through the neighborhood to the local patisserrie for a croissant and ice cream! Today has been wonderful. I can't wait to do it again.

Bonjour

I woke this morning to a beautiful Haiti morning, with soft cool breezes. The sun will rise and bring intense heat, but the compound was quiet and lovely before the missionaries/relief workers were up. There was the sound of my next door neighbors, two roosters, living in the compound across the street, taking turns crowing every few seconds from about 4am.
Last night's entertainment consisted of watching the Haitian men who live on the school compound play a rousing game of soccer against the relief workers and soldiers (who reside on the other side of the campus). There is no TV. About half the relief workers choose to reside in a small 'tent city' on the school grounds. The other half of us sleep in classrooms on airmattresses and cots we have dubbed, the "Hatian Hilton". We have electricity and running water, but no air conditioning. The Haitian women that live on the school compound provide laundry service and cook our meals. The school set communal showers, quite a luxury to have water for showers. They have the water trucked in and the tank refilled daily so we have enough for showers. Most workers shower at night after a long hot day. There is no hot water of course, but the cool showers feel exquisite after a long day in the tropical heat.
Last night I was assigned to a team going to a tent city. I thought I might get to go to a prenatal clinic, but I will see what this opportunity holds. Whatever comes to me, I will be grateful.
For breakfast we were served coffee, hot chocolate, croissants, beignets, assorted rolls and fresh fruit including oranges, pineapple, and mango. A wonderful way to start the day. My team is now packing up and we will be heading out shortly. I'm a little bit apprehensive. In the tent cities we have only what we carry in and our wits to guide us. It seems so little to offer, when we don't know what kind of cases we will see today. Our physician is a neurologist, plus one cardiac nurse, plus me, a maternal infant health nurse- kind of a hodge podge team. We do have the ability to make transfers into one of the local hospitals if we deem it necessary, but the hospitals don't always accept the transfers. Yesterday we heard the story from the OB doctor, that a young woman (age 20) came into the small hospital she was assigned to after being hit by a car. (The traffic here is crazy- someone probably gets hit everyday) The OB wanted to transfer her to one of the larger, better resourced hospitals, but it would not accept her, even though she had severe head injuries. She died about 20 minutes later. I felt badly for the OB, who also delivered a baby of a 17 year old with severe pre-eclampsia. They tell us we will see bad things, that we will feel overwhelmed, and that we may return home and need time to heal and adjust. All these things sober me, and yet and will do what I can and what I must to serve who I can. Whatever comes, I recieve with gratitude. My tap-tap awaits.

Night Falls Over Port au Prince

Night has settled upon Port au Prince. The air is still and warm. Our compound in Quisqueya is filled with American relief workers returned from a day of service in various corners of the city. Tonight in about an hour, tomorrow's assignments will be given out. I am tentatively scheduled to go out tomorrow with a Haitian American OB/GYN. I haven't met her yet, but I am eagerly looking forward to it. I'm glad to be partnered with someone who is fluent in the local language of Kreyol (Creole). Those returning from a day of work look exhausted, but are full of stories they eagerly share over our communal dinner of beans and rice and chicken in the open courtyard "dining room". I look forward to collecting stories of my own. I take deep breaths and try to be present for every moment. I am in Haiti. I want to soak in every detail. I want my entire focus on the here and now. That is how it must be, or one misses the experience even while in the midst of it.

I'm Here!

We have finally arrived in Port au Prince after two days of uneventful travel. The plane rides were comfortable and accommodating. On the flight into Haiti this morning, I sat next to an American relief worker, and struck up a great conversation. He at first thought I was Haitian (as most of the people on board were), but when I greeted him, he knew otherwise. I told him we were neighbors. His shirt had a reference to Omaha on it. (Omaha Nebraska is 3 hours from Kansas City) We ended up talking the entire flight. It turns out Brian had spent 10 years coming to Haiti for relief work, as well as lots of other interesting places in the world. We discussed the politics of international relief work, the history of Haiti and the impact of colonialism, and worked our way up to racism in America, and the impact of (American-style) christianity on other cultures. I don't often get to chew on such weighty topics. Drop in a comment Brian if you are reading this. Once we landed, Brian was headed to a destination about 100 miles away from Port au Prince. After reconvening with my travel companions, Matt and Emma, we got through customs and waited for the crisis center to send over a Tap-tap for us. A tap-tap is a makeshift taxi that consists of a truck, with benches on the truck bed to accommodate passengers. As we drove through PAP, we witnessed several rubble strewn streets and collapsed buildings. Otherwise life seemed to be going on as usual with people roaming the streets attending to the business of living. We passed many tent cities, and saw UN peacekeepers and military personel from several countries such as Egypt and Brazil. The compound where we are staying is Quisqueya School, a private school for American missionary children. They still hold classes for about a fourth of their students still in Haiti, but otherwise the entire campus has been re-made into a crisis relief command center. Relief workers from all over the US are camping on the spacious grounds or sleeping in former classrooms. The school organizes relief efforts in the city, and sends the relief workers out during the day to work at various Haitian hospitals. Today we rest, but tomorrow we will be sent out into the community to hospitals, orphanages, tent city clinics, etc. There is a cummunal kitchen house where Haitian women prepare our daily meal of rice and beans and chicken. It felt good to sit down to a hot meal and the food was delicious. The US military is here, they are in a separate school building on the compound and have been assisting with relief efforts. I'm meeting lots of nice folks, and the weather is quite pleasant. Much hotter than Florida, in the upper 80s but not uncomfortable at all. There is a constant breeze that makes it quite pleasant. Matt, Emma and I share a 3rd grade classroom with 3 others women from another agency. The school supplied airmattresses to sleep on and mosquito netting. We are provided breakfast and dinner. Haitian drivers take us to our sites at 8am and pick us up at 5pm. We have to get lunch on our own, but most folks have brought their own prepackaged food for that. I have a huge supply of protein bars that I plan to supplement with fresh fruit. We were told we can eat anything with a skin that can be peeled. We are encouraged to take our own bottled water which the school has in great supply. All our creature comforts are met so that we can focus on giving care to the Haitian people. Even this laptop I'm typing on and the wifi to transmit it to you are generously supplied by Quisqueya Crisis Relief Center. My companions have gone on a walk around the neighborhood to explore, but I intend to write, first to you Dear Readers of this blog, and them in my notebook journal. After that, a much anticipated nap! Thank you for your continued prayers, which have seen me safely here.

Three Planes Later...

I woke up this morning in balmy Ft. Lauderdale Florida. We have an early morning flight into Haiti. So far the most noteworthy event of the trip has been that I forgot my cell phone cord, so in a couple of days it will be useless. The temperatures in the 70s that I'm experiencing now, I'm told will seem cold compaired to the weather in Haiti. The sweet young couple I'm traveling with are veterans in foreign relief work, so I listen carefully and do all that I am told. When we arrived at our hotel last night, I saw a black postpartum cat. I could tell she was feeding kittens, and she was scavenging for food. Is this a foreshadowing? My heart remains open, to what the experience holds.

From Snow to Sun

The day of departure has finally arrived. I woke up this morning to find snow on the ground, after several weeks of spring like weather. Now I'm not quite sure how to dress. I am sobered by this journey, this opportunity. I know what I see will break my heart. The donations keep coming, even though my suitcase is past full. I hope to pack the remaining items with my traveling companions. There is still so much to do today. I try not to think about the immenseness of the task, I just focus on one thing at a time. I try to remain open, to whatever the experience holds.

A Force of Nature

I went to the thrift store yesterday and purchased a used suitcase. Found the perfect one. My kids and I sorted through everything and re-packed it all in plastic bags. I learned the proper way to pack a suitcase for overseas medical missions from Miss Mattie. I went to her house yesterday to pick up medical supplies. We ended up visiting for an hour as she showed me the little warehouse of medical supplies and medications she keeps in her basement. She was a wealth of knowledge and gave me many wonderful tips about traveling to Haiti. She is an experienced traveler to third world countries. She is just what I want to be when I grow up. I long to spend my "retirement" years traveling the world doing medical missions. Miss Mattie is a force of nature. She even has a scholarship named after her, sponsored by the Greater Kansas City Black Nurses Association. It was an honor to get to meet her, and carry away two boxes of medical supplies. Now the challenge is to fit it all into the suitcase, and not max out my 50 pound limit. Thanks again to everyone who has generously donated. I carry your spirit of love and healing with me.

Home Stretch to Haiti

The hunt is truly on for a bigger suitcase. The response on such short notice has been truly overwhelming. I think everything really can fit into one suitcase, but it must be a very large one. I will pack all donations into the one suitcase, and put my things into one small carry-on. I really am good at packing light, and besides I hate hauling a bunch of stuff around airports. Haiti will be an adventure. I've decided to wait until I'm there to decide if I will visit the midwifery school or birth center I've been invited to (they are on opposite sides of Port au Prince and both require an expensive chartered plane ride). When I went to get my malaria pill prescription yesterday, the nurse practitioner I saw, told me about her many trips to Haiti, and gave me more good advice. I have discovered so many connections between Haiti and Kansas City over the past two weeks. At a meeting yesterday, I was asked if I would be visiting Frank Vaughters facility (he was a much beloved Kansas City pediatrician that died in Haiti during the earthquake), but I have no news or contacts to his facility in Haiti.

I feel humbled and greatly sobered by this experience. I don't know if I'll be up to the task, or if an L&D nurse will be useful. (They really need surgical nurses, orthopedic nurses, wound care nurses). All I know is I will go with an open heart and do my best.

Calling All Condoms

Donations continue to arrive daily. I'm so pleased by everyone's generous donations. All the donations are laid out in separated piles on my dining room table, in preparation for packing. When I walked in the door last night, my kids came running up to me, "Daddy stole from the Haitians!" "What are you kids talking about?!" I was thinking, what could he possibly want from the dining room table? It was full of prenatal vitamins and hairbows, and .... Condoms!!! I tracked him down. "Honey, did you take something off the dining room table?" He smiled shyly. "I only took one." "Did you really think you were going to get lucky with a stolen prophylactic?" I asked.

On a serious note though, more condoms would be greatly appreciated (I promise to protect them from both husband and teenagers). The blog from the crisis center mentions unplanned pregnancy and complications from abortions were a growing problem. As is typical after a disaster, so is sexual abuse and assault and physical abuse of women. Women and children are just more vulnerable after a disaster, as social constructs (and the men) that protect them fall away. Condoms are just one small tool in an arsenal of protection for women. I hope to give them that tool. Condoms protect against both sexually transmitted disease, and unwanted pregnancy. No other contraceptive device offers both.

Quisqueya Crisis Relief Center

I have discovered a blog about the place I'm headed to in Haiti:
(warning, some of the photos are graphic)

http://quisqueya.org/qcsrelief/category/relief/

Donations for Haiti

I have been delighted with the donations rolling in from everywhere. I'm definately going to need a bigger suitcase! I've already been thinking about planning a couple of travelogues when I return, perhaps one at my church and one at my school. I'll do them sometime in April. I'll set up another event page on facebook and post them here in the blog. Everyone has shown such an interest, I'd like to offer them something for their good will and donations. The only preparations left are to 'acquire' a camera and pack all my donations. My spirit is at peace for whatever the experience holds.

Haitian Dreams

I had dinner with someone who was in Hinche last month. It was very informative. It has been incredibly helpful to talk to people who have been there. The pastors prayed for my trip in church yesterday. I had many well-wishers and prayer partners. This is such a comfort. I do not wish to undertake a journey like this without the prayers of many. Everyone has been kind, encouraging, and generous in supporting my efforts. I got lots of shopping done over the weekend, and have packed my bags. Now I just wait for more donations to arrive. I read books about the bloody history of this country, and try to recall my high school French. My dreams are of Haiti.

Getting to Hinche in a Cinch

Now the ball is starting to roll. I just received an invitation to teach lactation support to Haitian midwifery students at a hospital in Hinche Haiti. I don't know how far Hinche is from Port au Prince, but it does involve a plane ride. Now it's time to get the universe moving. I need this to happen. I already have a text book to use for the teaching, it's a simple text written for developing world maternity care workers. However it is in Spanish, I need it in French or Creole. I'm trying to contact the publisher and the writer, Dian Doody MD, who happens to be a pediatrician from right here in Missouri. Any assistance you can give Dear Readers would be greatly appreciated. In less than a week, I must get the book translated, printed, and funded, or find another one just as suitable, already written in French, and make plans to travel (probably alone) to a distant city. The universe can pull that off, right?

Mission to Haiti

The facebook event page is up! The "event" is called Mission to Haiti and you can link to it here. Now that I've taken care of getting the work out, I can focus on getting myself ready. I've made an appointment to get my immunizations and a prescription for malaria pills. Today I'll find a French phrase book and a pancho. Someone gave me a wondeful website, Midwifes for Haiti, that was full of practical advice. I still need to contact the list of drug reps I have, to hit them up for medication donations. I will also try to make contacts so that I can visit some of the midwife run birth centers in the outlying areas. I want my soul to be open to whatever the experience brings.

Haiti Countdown

I met with Captain Belardo yesterday of the US Public Health Corps. He was just 10 days returned from a 2 month assignment in Haiti aboard an aircraft carrier converted for hospital use. Though he and his team were charged with water sanitation, and human and livestock immunization, the most difficult cases were helicoptered back to the ship for surgical procedures. He showed me hundreds of photos he had taken of crushing injuries, broken bones, amputations, burns, and severe bed sores (stage IV!). It seems the injured would lie for days unable to move themselves and without anyone to move them they would develop bed sores. He stated how sometimes the press overhypes things and blows them out of proportion, and how he was surprised to arrive in Haiti to find things much worse than anything he saw captured on CNN. The only redemptive element he found was 'the spirit of the people.'

I asked him specifically about maternal-infant health and was surprised to hear him mention the importance of breastfeeding. When I pointed out that most disaster relief folks want to rush in the formula after an event, he chuckled and confessed to being an old MCHBer (Maternal Child Health Bureau of Health and Human Services). Then he look very serious and said formula would be disasterous to send formula to Haiti- they barely had clean water before, they definately don't now. I was so relieved to hear someone in a government uniform was getting it. Don't send formula, send lactation support workers!

However, I digress. When I asked Captain Belardo what I should take with me, he informed me that I would be arriving during MANSOON SEASON! Yikes! Not just little periodic rain storms, he tells me, but hard driving rain and wind for days on end- but still in the 90s everyday. Sounds like hell with a beach. I asked about immunizations and was told: malaria, hepatitis A, and tetnus. When I told him I was thinking about skipping the hep A, he leaned across his desk, peered over his glasses and said, "Don't." Okay, then, Hep A it is. When I asked for what I should ask for he helped me to ammend my list to the following:

• baby slings
• folic acid and prenatal vitamins
• antifungal cream
• hair accessories
• condoms

Ok, the last item might throw you off a bit, but Cap. B assured me that sexually transmitted disease was EVERYWHERE, including AIDS (that shouldn't come as a surprise in a third world country without a public health infrastructure). I did remember from my previous research that STIs and uplanned pregnancy rose precipitously after a disaster (so do sexual assaults, but that's another story). He said he made fast friends when it became known he had condoms to give out. I was just lecturing my students earlier this week about the long term effects on female fertility from recurring bouts of genital infections- it ain't good news. So to promote maternal health, I'm going to pass out condoms to every nonpreg woman I see.

All in all, a very helpful visit. Working with pregnant women seems a little anticlimactic in the face of such devestation, but I know every little bit helps.

Haiti to do list

To prepare for my trip to Haiti, I need to do the following things:

• get immunized (malaria, tetnus, etc.)
• create an event page for facebook for donations
• have two coffee dates with the two folks I know who just returned from Haiti (a captain in the US Public Health Corp who spent two months immunizing people and livestock, and a midwife who recently returned from 2 weeks there) in order to pick their brains
• learn a few Haitian terms
• review the history of Haiti to gain some understanding of the culture
• acquire a digital camera and an extra memory card
• make my packing list- it will be short, I plan to forgo make-up, and live in scrubs
• continue to cultivate an open and accepting attitude (I've been re-reading The Four Agreements)
• organize things at home so as not to unduly burden my husband
• organize things at work so as not to unduly burden my teaching partner
• ask for prayer from my church
• I'll think of other stuff, or you can offer some suggestions

Preparing for Haiti

It is now official, so I can blog about it. I'm going to Haiti in less than two weeks! From March 20-28, I will be in Haiti working in a crisis relief center with pregnant women. I can hardly wait to go. I will be going with Mercy and Truth Medical Missions and will meet up with other healthcare providers from other organizations working at the relief center. All I know so far is the relief center is housed in a school, and we will have accommodations there as well. Meals will be provided by the military. Here is where you come in. I would love to give folks the opportunity to give to this effort. I am accepting the following items to take with me:
1. fabric slings to give to women with small babies
2. unopened bottles of prenatal vitamins and folic acid
3. small vanity items for women and girls such as combs, hair accessories, hair bands, ponytail holders, hair clamps, barrettes, etc. (Nothing bigger than a banana please)
If you feel compelled to give money, please give to one of the fine organizations already set up to take donations such as the Red Cross. My trip will be completely self-financed (I plan to take it off my taxes next year.) I will post more information as it becomes available. My goals for the trip are the following:
1. Serve in whatever ways I can
2. Observe and learn more about the gaps in disaster relief services for maternal-infant populations
3. Document everything (in both words and pictures)
4. Practice maternal health nursing skills
5. Participate in some births
6. Experience and appreciate an entirely new culture
7. Become better and stronger as a nurse and person

Breast Lecture Ever

Today is my lecture on lactation. I have two giant breast pillows to discuss anatomy. I have a breastfeeding bingo game I made to discuss benefits. I have a brand new $260 video from INjoy to highlight correct technique. I have posters, infant models, anatomical drawings of breasts in full color to introduce all my content. I think I'm ready. This lecture delights my soul because I usually make at least a few converts, but there are always the resisters. The trick is to deliver a message that touts the virtues of lactation without making those who did not choose it feel guilty. Why does this induce guilt and defensiveness??? I can't think of another topic that impacts folks with quite this intensity (on a day when we also discuss human sexuality, abortion, contraception, teen pregnancy...). My goal is to enthrall students with the wonders of mother's milk, and equip them with basic skills to support the newly breastfeeding mother. I'll let you know how it goes...

Stand and Deliver

We were having dinner with three other couples from my church the other day. The hosts were a sweet young couple having their first baby. After dinner we played a pictionary type 'parlor game' that involved drawing a picture of a woman having a baby. I was very proud that my husbnd drew a picture of a woman giving birth standing upright! When I pointed out his drawing in contrast to everyone elses of a prone woman with legs elevated, the hostess asked, if that's the best way to give birth, why is it done lying down? When I said for careprovider convenience, I got dead silence. I dread conversations about birth anymore. I never say what people want to hear. It's all bad news. A couple of weeks ago when I asked a co-worker how his baby's birth went (I need to stop asking that question), he gleefully told me all about his wife's induction and how wonderful the whole thing was. I smiled politely and nodded. I can't speak nicely about birth, and I can't write nicely about it either.