Labor Repose

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

Saturday, April 24, 2010

Old Hippie, Talking Smack

Ina Mae is here in town! She is speaking at a conference here in town. Here is a snapshot of her I took in California last Fall. For those who don't know, Ina Mae Gaskin is a pioneer in birth here in the US. She and her band of hippie followers started a commune in the 1970s in Tennessee devoted to (well lots of things, but one was natural birth) that triggered the homebirth movement here in the US. When I read her book, Spiritual Midwifery in 1978 as a 15 year old pregnant teen, it transformed my thinking on childbirth and truly set me on the course I am today. Her recent work on maternal mortality is, like her work on homebirth, ahead of it's time. She is a true hero to me. I've seen Ina Mae speak lots of times, but never here in my city. She rambled on the way she does in her stream of consciousness style of speaking. Her photos and stories of the commune days are always enjoyable. Her rantings about the benefits of 'socialized medicine' don't play as well here in the conservative midwest. A natural born storyteller, she was at her best, telling birth stories and spouting 'old folk' wisdom. What was best about the presentation was actually her audience- the people she drew to her. The audience was chock full of nursing babies and moms, as well as every type of midwife imagineable. That in itself is a feat. Ina Mae is one of a few people who can draw CNMs, CPMs, and DEMs, all to the same table together. I loved that audience. It was full of MY people. I wanted to rush around and hug everyone. I know all those women (and some men) are out in the world doing their thing to make birth better. I'm looking forward to the second day of the conference today and the learning and networking that will take place.

Tuesday, April 13, 2010

Travelogue Today

Today I will be holding the second of my three travelogues about my trip to Haiti at Brown Mackie College in Lenexa at 12-1. Anyone is welcome to attend.

Sunday, April 11, 2010


Since I have returned from Haiti, folks often asked me, what is the single greatest need. My answer is always, unequivically, infrastructure. Like the bones of a body or the steel beam skeleton of a building, infrastructure is what you hang everything else on. Haiti lacks a public healthcare infrastructure from what I observed. This is why I fear there will be many more deaths to come. With the advent of the rainy season, standing water means disease, and in the tent cities, disease will spread like wild fire. Public health requires a preemptive strike such as immunizing against possible communicable diseases. Secondarily, you enact measures to control the spread of diseases that are not preventable, such as treating disease as it occurs. Third, you can teach prevention, such as teaching the public to cover their coughs, not share cups and glasses, wearing masks, etc. I see these kinds of public health teaching and public awareness campaigns as very difficult for a country that can't even keep electricity going throughout the day. Public health is built on a healthy infrastructure of rapid public communication with common goals and mission. Just the fact that so many countries have swooped in to help without a Haitian bureacracy to oversee it, betrays a lack of organization. I saw very little structure to the relief effort. My experience at Diquini Hospital was a prime example. On my last day, with the two American OBs, they sought to impose structure. I numbered all the beds and all the charts at their request. But the Haitian nurse saw it all as a nuisance. She had her own order, and it had nothing to do with ours. There is no consistancy in place to ensure that the 'order' we imposed on the unit will remain. When we left, it most likely went away as well. That is what Haiti needs, an imposed authoritative systemic order for delivering healthcare to a population that continues to have chronic healthcare needs apart from the acute ones imposed by the earthquake. A woman should not have to have her yeast infection treated at a temporary tent clinic. There should be a healthcare structure for that. How does Haiti acquire this public health infrastructure? Well that's another post entirely.

Friday, April 9, 2010


The dates are set. Here are my 3 upcoming travelogues about my trip to Haiti:
This Sunday: April 11, 2010
Cornerstone Community Church
74th and Metcalf
Overland Park KS
12:45-1:30 pm
Next Tuesday: April 13, 2010
Brown Mackie College
9705 Lenexa Drive
Lenexa KS 12-1pm
Next Sunday: April 18, 2010
New Life Community Church
16111 Vicie
Belton MO
1:00- 1:30
I'll also update everyone on my plans to return, and hopefully take a team of folks (including you) with me.

Thursday, April 8, 2010

Church Clinic

All these images were taken at our clinic held in a church. We didn't know at the time how luxurious our accommodations were. We were sheltered in a building out of the heat with private areas to talk to patients and give exams. Our entire team is pictured along with our interpreters. YaVonne in pink is a cardiac nurse, Emma ran our pharmacy, the other woman in green is a neurologist from New York, and my interpreter Kicki. We all worked well together and saw about 100 patients that day.

Quisqueya Calling

What a week. My students have been wonderful and clammering for a trip to Haiti! I even got the idea into my head to ask some local philantropists for the money to take them. I may be getting a little ahead of myself. My proposal for MANA was turned down. It wasn't very good anyway, and my book won't be ready by this Fall, so it's just as well. I am submitting a proposal for City Match though about Lessons from Haiti. All my speaking proposals for the next year will be about lessons from Haiti frankly (fined tuned to each conferences theme of course). Right now I'm busy planning at least 3 travelouges. Look for them on Facebook events. I really want to go back to Haiti as soon as possible. I recieved an email message from Quisqueya asking for medical teams to come. How can I make this happen?

Sunday, April 4, 2010

Haitian MD

I learned about a phenomenon that is probably ubiquitous in international medicine, and relief circles. It was however, new to me. On this particular trip, it was referred to as 'getting your Haitian MD.' I'll tell you a story that illustrates this phenomenon.
While at the Haitian Family Mission on the fourth day, we were in the midst of our outdoor clinic, under the almond tree. A man arrives carrying his crying little boy. Being in acute distress, they are ushered to the front of the line. The little boy has lacerated his finger while playing atop a building debris pile. (Remember, the piles of rubble are everywhere. Most of the buildings appear to be built of concrete, and it is piled mountain high with wires and metal pipes shooting out all over. They must be very tempting for a little boy.) It is a very severe cut requiring three or four stitches. There is no doctor with us on this particular day. I am on a team with a pharmacy tech, a couple of medics, an EMT, and a non-medical. The doctor working with the mission is on vacation. I am selected to do the stitches. Now I have only done stitches on uncooked chicken breasts. But thats more experience than anyone else on the team. We could send him to a hospital, but he might wait hours (even days). He's at the top of our clinic list, but he would be at the bottom at a hospital. So I resign myself to doing my first stitches on a real person. I draw up the lidocaine after locating a suitable needle and syringe and am about to administer it when I hear, "Here comes so and so, she can do stitches. She does them all the time." Talk about saved by the bell. I happily hand my syringe off to so and so and proceed to assist her as she administers four neat and tidy little stitches into the tiny finger. After she's done I wrap the finger in guaze and with the help of an interpreter, give Dad instructions on care and returning to have them removed. This shouldn't be a problem since the stitcher lives at the mission. Later in the day, when I ask the stitcher what specialty of nursing she practices, she stated matter of factly that she wasn't a nurse at all. Taken somewhat aback, I asked her what her training was in. She told me her formal training was something akin to a medic (I'm not sure what that training is.) I ask her where she learned to do stitches. She told me that even though she has very little formal training, she learned her skills from various doctors and nurses that pass through the mission. They let her observe and try skills out as they guide her. She got her training informally, hence, the "Haitian MD." She wore a white lab coat and had a stethoscope around her neck. It's true that even I was diagnosing and treating in the tent cities. I was treating diseases I had never even seen or heard of before. Does this sort of thing result in subpar care? I'm sure it must. Twice, my interpreter KiKi diagnosed my patients when I had no idea what I was looking at. A child came with a hard white plaque on her tongue and upper palate. I thought it was yeast until I palpated it and found it hard and unmoveable. I had never seen anything like it. I asked the other healthcare providers. They didn't know either. Then KiKi spoke up. "I don't know what the name is in English, but in Kreyol, we call it 'shunk' and they treat it by rubbing it with lemon and salt until it is rubbed off. It comes from kids putting all kinds of dirty things they find into their mouths." Well that was good enough for me. "Kiki, tell the Dad what you just told me, and tell him the treatment." I was horrified to think what that pretty little girl had put in her mouth to cause that awful looking fungal growth. She could no longer eat, and could barely talk. I shuddered even more to think of her Dad scrubbing her tongue with lemon and salt until it bled. But hey, I couldn't come up with anything better. The home grown cure seemed reasonable to me. We didn't have any antifungals except those to treat a yeast infection, and this was no yeast infection. In that moment I didn't think of KiKi as overstepping his bounds as an interpreter. I was very grateful to him for giving guidance on something I had never seen the likes of. My trip had been filled with many moments when I was looking around thinking, 'should I be doing this?' (things I would never be allowed to do 'back home.' But I wasn't at home. There was no one else to do it and I was knowledgeable (sometimes) and willing (everytime). In those moments, I know I too was getting my "Haitian MD."

Saturday, April 3, 2010

Art and Miquette

This lovely couple were our hosts at Quisqueya. Art ran the day to day operations, and Miquette gave us our daily assignments. They kept everything running smoothly for all the relief workers. Thanks Art and Miquette for all your hard work.

Friday, April 2, 2010

Kickolito- The Hope of Haiti

My interpreter, KiKi, is a 21 year old young man, with an earnest face and wise, old eyes. He is seated next to me in this photo with the baseball cap. I fell in love with KiKi. Unlike many of the interpreters (all bright young men from 19-25 years old) who joked and laughed, KiKi was always serious and focused. When we finally got a chance to chat, he told me his father was deceased, and he lived with his mother, and two younger brothers (18 and 14). He also has an older sister, but she lives on her own, so at 21 he is the man of the house. He spoke about the restoration of Haiti. How he wants to be a part of seeing her restored. I asked him what he wanted for himself. He said he is interested in designing energy efficient automobiles. That he plans to attend college here in Haiti. He thanked me for coming to help the people of Haiti. On our last day together, I wanted to take him out to dinner, as a thank you. He refused, stating, "If I come home late, my mother will worry." I thought of him riding home, an hour away in those crowded city tap taps. I asked him if his home was damaged by the quake. He said no. I can't imagine what life is like for him, and yet I feel such an affinity to him. Kiki is Haiti to me. If and when I return to Haiti, it will be partly to know that he is well.

Thursday, April 1, 2010

Images from Haiti

These are my first few images to post, in no certain order. There is a picture of me and my interpreter, Ki Ki, in a tent city clinic. I am giving instructions to a Dad on how to administer a medication to his child.
There is also a photo of me standing in front of our tap-tap that took us out to clinic everyday. The cages were for our safety. Driving over those bumpy roads could cause someone to fall out.

Position, Position, Position

I just have to say that those Haitian ladies really know how to move in labor. Without medications to keep them drugged and bedridden (they are no beds either after all!) they get up and move throughout their labors. In early labor we have them walk and drink water. During active labor I saw them sway their hips, kneel on the floor, get on all fours and sway back and forth, crawl around, stand and squat repeatedly, bend over holding on to beds and tables, lean against loved ones while squatting between their knees, tailor sit, and on and on and on. Because the women squat a lot while doing chores and cooking, they found it really easy to get into positions I can only dream of getting into. I was really impressed. The positions they were using as they labored, really allowed the pelvis to open and the babies to come down. More than once I suggested (to the OBs, not the midwives) to let the moms off the delivery table and let them move around. I did very little to direct their movement. I let them do what felt good to them and they sure showed me some new stuff. They were all over the floor. No birth ball needed! I never saw American women do the kinds of positioning I saw the Haitian women doing. Some were absolutely silent, but others were very vocal with their contractions. They chanted and even sang throughout their labors. I learned so much about the wisdom of the body in labor as I observed and worked with the Haitian mothers. My homebirth experience really prepared me to be useful in this kind of birthing environment.

Paradise for Babies

I was en route to Diquini hospital on my fourth day in Haiti when I passed a huge billboard that read: " Paradis Du Petites." There was a picture of a lovely Haitian mother holding her beautiful baby. Paradise for Little Ones. I assumed it was advertising a school or daycare center. But in truth, Haiti is not paradise for babies. The infant mortality rates are among the highest in the Western Hemisphere. (Maternity mortality rates are high as well.) I still wonder if that baby I saw on the first day with typhoid fever and a temp of 104 ever made it to the hospital. I understand the obstacles that keep families from going to the hospitals. First they need a way to get there. The hospitals are few and far between. Then they may wait many hours to be seen. If their child is then admitted, the family has to stay as well. Hospitals may not provide linen for the beds, or meals for the patients. Some may not give medication unless is is paid for first. Speaking of pay, financial burden is a big barrier as well. The hospital will insist on being paid and the family may not have the resources available. Babies with fevers and diarrhea are in a race against time. They may succumb to the dehydration before the fever breaks. Most of the babies I saw were on the downside of the disease process and were already afebrile. I was told that often if a mother sees her baby is ailing, she will emotionally detach from it. I was also told that if a hospitalized child appeared to be failing, the parents would leave the hospital and not return. I cannot judge how people find a way to cope in the face of such overwhelming challenges. I noticed that it took some work on my part to get the new mothers to warm toward their babies. Fortunately the grandmothers or aunts or female cousins were there to model bonding behavior. We often broke with hospital protocol and allowed the families to be with the laboring mothers. The Haitian doctors would shoo them out of the room, but when they left, we would let them right back in. I loved it when one of the midwives greeted each new baby with, "Welcome to the world, you are the hope of Haiti" and indeed they are.