Labor Repose

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

Wednesday, May 25, 2011

Making Do


One of the many things I have observed while here in Haiti, is that folks know how to make do. They have come up with all sorts of ingenious ways to get what they need with such limited resources. As I sat on the balcony of my quarters yesterday, I observed a little open air, makeshift babershop in the tent city next door. As the customer sat in a chair, the barber appeared to comb his hair with what looked like a comb, but it must have had blades on it, because as the barber 'combed,' the customer's hair came off in little clumps. I have never seen a haircut of this type without an electric razor. The end result was a nice clean shaven head.

Later in the day, Monseiur was almost out of the little squares of paper he used to write his instructions or prescriptions on. I saw him print of sheets of paper with four little squares on each with his name and address centered at the top of each one. I offered to cut each page into four equal sheets for Madam. I looked around for scissors and seeing none, I was about to leave to go to my room and get my pair, but before I could go, Madam grabbed a knife off the shelf and showed me how to fold and then neatly slice through the folded pages to make the little pads of paper.

Later, I was washing my hands in a sink and noticed that someone had made a little sink plug from a plastic bottle cap. A small hole had been drilled in the center, a string passed through and knotted and tied to the faucet handle. The little cap fit perfectly into the opening of the sink.

I think the Haitians must make, "making do" a daily occupation. They are resourceful in a way I am seldom called upon to be. Monsieur holds constant diligence over the electricity that flows into the compound. Nothing will bring him up the stairs of my quarters faster, than if he notices my lights have gone out. "Did all the lights go out?" "Does the bathroom light still work?" " Does the fan still work?" He asks as he turns all the switches on and off. He stands there for a moment contemplating, then calls his hired man on the phone and talks to him very quickly in Kreyol as he heads down the stairs to tinker with his generator. My room, like all the rooms of the clinic are half government electricity, and half generator electricity. There is a backup generator for the delivery and postpartum rooms. The government electricity and whatever it powers is often out. Monsieur tries to ensure that whatever is essential is on generator power. It appears my fan is on one grid, and my light on another, even though they are a unit (a ceiling fan with a lamp attached). I laugh and tell Monseiur I do not mind if my lights are out, but he clearly does.

He devotes time to each day tending to electrical issues throughout the clinic. I see minimal reliance on electricity but he does have an fetal heart monitor for labors and a colposcope and ultrasound for the clinic. His doppler is battery powered. In the clinic is a computer, 2 printer/faxes, a television, a fridge in the family quarters, and a camp stove with 3 burners and assorted small electric kitchen appliances that Madam uses for cooking such as a coffee maker and blender. They appear to try to ease their reliance and something as unreliable as electricity. For a few hours yesterday, both the government power and generator were out and it became very hot in the clinic without the ceiling fans. We were all sweating profusely through our clothing. The back-up generator powered a few lamps to see by. I try to imagine doing my job as a labor and delivery nurse all the time worrying about whether or not I will have electricity. Of course, that is only one of a long list of Monseiur's concerns throughout the day.

Yesterday was a half day clinic which occurs every Tues. and Thurs. When clinic was done I walked down the road to visit at the Heart to Heart clinic I volunteered with on my visit last Fall. I ran into my former interpreter, Mose. I asked Mose if there was a restaurant nearby. My former interpreter Kicki is coming up from Port au Prince tomorrow and I want to take him out for a meal. Mose offers to walk me there so I can see it. We walk a surprisingly short distance to an open air restaurant playing loud "Kistian" music as Mose informs me. We are the only ones there. This does not surprise me- it is 'siesta' time (the hottest part of the day) during which everyone retreats. I'm not even sure the Haitians 'do' lunch. At any rate I ask Mose to try out the menu with me so I'll know what to order tomorrow. We order cold sodas and two 'poulet'. The menu is a white board on which is written: poulet (chicken), cabrillet (goat), poisson (fish), etc. Nothing is written as to how they are prepared or what they will be served with, so though I know we will be served chicken, I know nothing else about the dish. About 20 minutes later, the waitress sets down plates with fried chicken (here it is done with out the skin, without any coating, or without any spices), french fries, picklese (a vinegary slaw made with hot peppers that I love), and fried plaintain. It is a small feast! I thank Mose profusely for showing this place to me.

Later that evening, I enjoy another lovely meal as Madam has prepared fish I ( I don't know what kind- but its flesh was thick and tender and flaky), cooked in the most delicious broth with tender onions and peppers floating in it. The household cats smell the fish and harrass me all through the meal. This is served alongside rice and beans, and fried plantain with ice cold lemonade. I secretly wish for some picklese to go with the fish, but it is a delicious meal.

Just after I retire to my quarters for bed, Monseiur comes up to tell me, that a patient has arrived in labor, but not to worry, she is a primip (first timer) very early in her labor. I was to go on to bed and he will call me when the time is at hand (Monseiur gave me one of his cell phones to keep with me, so that I could reach him immediately in case of an emergency or he could reach me for a labor). So I go off to bed and the phone rings around 1 am. I answer it, but it is too late, the caller has hung up. I think, of course it is Monseiur alerting me to a change in the labor. I rise, dress, and head down to the clinic. I find the patient dilated to six, and Monseiur saying he did not call me at all! It must of been a wrong number. Nonetheless, I am introduced to the patient and without waiting at all, I jump right in and start laboring her on the very first contraction I witness. Monseiur goes back to bed, while Francios and I quickly settle into a labor routine. I get a wet cloth and start fanning her between contractions. During contractions, I apply counter pressure which she quickly insists on for every contraction. Not being able to speak her language, I smile a lot, and encourage her with the little Kreyol I do know. She is in the postpartum bed, since Monseiur expected her to labor most of the night. I want her to get out of bed to try standing for her contractions, but I cannot communicate this concept, and give up after a couple of attempts. When she feels a constraction start, she looks for me and holds out her hand. I come quickly to her and press one palm forcefully into her lower back (only on her left side- she doesn't want it on the right) and with my other hand I gently stoke her leg downward and out. At the same time I breathe slowly and deeply blowing out pursed lips to model how her breathing should be (she doesn't follow!) Instead of my slow deep breathing, she chants the same phrases over and over. I do not know enough Kreyol to know what she is saying, but I know it comforts her. We go on like this for about an hour and a half as her contractions come closer together. Monsieur emerges from his bedroom. He says he heard the change in her voice and he will check her now. She is dialated to eight and we walk her into the delivery room. In another hour, she has delivered a fine boy whom Monsieur strangely dangles upside down by his feet until Madam takes him. He cries robustly in protest the entire time. An episiotomy has been cut, so the repair must be done. After cleaning her, Madam and I stand her up to walk her back into the recovery room where her baby and kinswoman wait. We get about four steps and Francoise faints dead away between the two of us. We help her gently to the floor and call for Monsieur. He comes quickly, she awakens and we put her back on the delivery table. She passes several large clots. More pit is added to the IV bag and oral cytotec is given (though her uterus was always firm) and an internal exam is done. After some rest time, we try again to walk to the recovery room- this time success. I help Madam clean the delivery room. Francois is very sweet and thanks me. I beam at her new baby boy and compliment him profusely. Monsieur walks me up to my quarters because the outdoor light is out and he uses his cell phone for a flashlight. (I think he really wants a chance to flip the light switches in my room off and on again!) I crawl back into bed at 4 am thinking, maybe I can do this nighttime on call thing after all, and I fall asleep immediately.

4 comments:

Midwife in Training said...

You mention how you helped mom labor while Monsieur went back to sleep, is it a normal situation for the moms to labor alone usually? If you werent there would she have someone with her?

Also, I love and am greatly inspired by how resilient many countries are that have little, but live as though they have tons. Its a lesson for us Americans right lol.

LaborPayne said...

MIT,
From the births I observed at the hospital during my first visit to Haiti and the clinic here, I have observed that the mothers almost always bring someone with them (usually it is not the father, but a kinswoman). However these individuals typically sit near by but remain silent and do not touch the laboring woman. I've also seen that family members will provide labor support if you show them what to do and give them permission to do so. Most mothers have one or two women with them during the labor to give a human presence, but support is a different thing. All the Haitian doctors I've seen in deliveries do not welcome family members or support people into the deliveries. So I would have to say, the Haitian women do not labor alone, but neither do they labor with hands on support.

Midwife in Training said...

So perhaps a cultural phenomena of the physical presence of other women. The fact that they are willing to physically support when shown says a lot. Do you get awkard stares when you lay on hands? I dont mean to sound ignorant, I guess I am just trying to discern how the "doula-like" roll can be embraced and maybe show how much better the moms birth experience can be. But I know that cultural standards are one whole other thing too.

LaborPayne said...

MIT,
You are correct about straddling the line of cultural appropriateness. When I labor women, I first avoid the gaze of whomever else is in the room except the mother, because I definately DO get crazy stares. Once they see how the mother responds, they relax. (I think they just want to know I'm not doing some crazy Mojo on her- this is Voodoo country after all- and meaning is applied to everything.) The concept of doula does not exist here, yet they do understand the importance of the physical presence of a caring female.