Labor Repose

Labor Repose
LaborPayne during her 6th homebirth (9th baby) at age 44

Monday, October 4, 2010

Day 3- Operation Haiti

Today saw another early start, as four of our small group took a short tap-tap ride to the beach and set up a clinic under the palm trees. We saw about 50-60 patients, some we could help and as always, some we could not. After we had seen every patient, my colleagues took a dip in the ocean while I enjoyed the scenery (I'm not a swimmer). We rode back 'home' to our little maternity hospital and I took a nap until dinner. Tonight we were served a potato, yam and beef stew and white rice with a pureed bean sauce. I've since spent 3-4 hours reading homework (I have a pathophysiology test when I return home) and am finishing a long day with my journal. I'm short on detail because I'm tired and in need of sleep, but it has been another amazing and thought provoking day. We had great discussion over dinner processing what we are seeing: the nature of health and wellness, the geopolitial and socio-economic basis for health, the upheaval of Haiti, the nature of family, the meaning of hope and happiness. Sometimes it is all too much to take in at once. Thank goodness for interludes of blessed sleep.

Addendum: Now with some sleep, I'm ready to reflect upon a couple of events yesterday.

Most interesting case: We saw a boy of 12 years yesterday with severe cahexia (not just lack of fat, but lack of muscle- literally skin and bones.) He was with his mother and younger brother and sister all of whom were well nurished and looked fine. His mother stated that he had been sick for two weeks and had no appetite and diarrhea, but his severe state looked like it took a lot longer to produce than two weeks. He was flaccid and lethargic (not surprising- we produce our energy (ATP) in our muscle fiber and he had very little) and had a very flat affect. He was given a referral to the hospital for follow up care. He was heartbreaking to behold, and difficult to even look at. I felt this child might be dying and there was so little we could do. We talked about him long after clinic. We have no diagnostic equipment to diagnose so we can only guess at what the problems are based on clinical manifestations. Did he have severe and prolonged intestinal worms? Was it neonatal transmission of HIV/AIDs? Did some combination of opportunistic infections tax his immune system to the point it wasn't fighting back? Sadly, there is no way to tell. Worse still, no way to tell if his mother took him to the hospital. You need money to pay for healthcare up front. Without money, they'll be turned away, no matter how dire the situation. The hospitals here do turn people away for all kinds of reasons. I can only hope that emaciated boy with the haunting eyes gets the medical attention he so desperately needs.

Most interesting observation: In Haiti everyone breastfeeds. It is a given. However, based on my observations, they don't breastfeed nearly long enough. Now they do nurse their babies for the first year, maybe two, but in this healthcare environment it is not nearly long enough. The reason I say that is the sheer number of sick and compromised babies I see once they are weaned from the breast. If ever anyone doubted the immunological benefits of mother's milk, they should come to Haiti. The minute these babies are deprived of their mother's milk, their immune systems struggle to handle the daily assault and onslaught of disease bearing pathogens. Breastmilk is their best protection, and once deprived of it, they become ill, very ill. I heard one of the nurses say that doctors are telling Haitian women to wean earlier, like at six months. This would be disasterous. I asked why would anyone do such a thing and she said because of the risk of HIV/AIDs transmission. This set my blood to boil. Not only are the benefits of lactation proven (if anyone would bother to read them) but the who relationship between lactation and AIDs is still up for debate. To deprive these infants of their best immunological defense seems, well, indefensible. I make a note to ask every mother of a baby if she is still breastfeeding and encourage her to continue if she is.

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