Labor Repose

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

Saturday, May 28, 2011

The Salvation of her People

I sit in a cool air-conditioned room of Jennie Joseph's birth center in Winter Garden Florida. Much has transpired over the past three days. I'll begin at the beginning.

On the last day in Dr. Delson's clinic, I awoke to the surprise of three laboring women. I had hoped for at least one birth per day, and it seemed as if I would get my wish plus a bonus. Mother 1, 42 years old, came in during the night, a multip on baby number four, dilated to four. By morning she was at six. Mother 2 was a multip, dilated to 3. She lost a child in the earthquake last year, as did Mother 1. Mother 3, 27 years old, was a primip. They all labored nicely all throughout the clinic day as Monsieur saw a full slate of clients- it was actually our busiest day, even though it was only a half day clinic! He got through them all quickly and efficiently in order to attend the laboring mothers.

He expressed concerns about Mother 1 because she was large for dates. He wasn't sure if she had an extra large baby or an excess of amniotic fluid. He turned his attention to her first. The ladies in general were left to labor on their own with whatever support person they brought with them. They walked the courtyard and waiting room floor, and layed on the benches or on a bed, and in general did not make a fuss. After clinic Monsieur checked all the mothers again, and found Mother 2 and Mother 3 had made some progress, but Mother 1 was still at six. He put her on the delivery table and added 10 U pit to her IV (I didn't mention before, but there was no IV pump- all IVs are to gravity by drip, in case you were assuming there was. I myself had never seen gravity pit for induction/augmentatation and was amazed to see it regulated in this way- though mostly it was a very slow drip, but not at all titrated, only slowed down or sped up to his will.) After a couple of hours, she was still at 6, as she had been since morning (this was now early evening). Monsieur looked uncertain but he decided to act on his instinct to call in his anesthesiologist- from Port au Prince, two hours away. Now I began to see the gravity of his situation. Mother 1 and her baby were in no immediate danger, but to even consider a cesarean as a possiblility, Monsieur would have to plan two hours out. After reaching the anesthesiologist for the surgery, he found that she had sent her own car to pick up her children away at school, she was available to come, but she did not have a way. Dr. Delson immediately dispatched his own driver to pick her up. This added to the time and would now be four hours instead of two for the surgery. He thought this gave Mother 1 more time to labor on her own and push the baby out if she could. I began to appreciate how difficult his job was and how difficult a call this was to make- getting a surgery that might be unindicated vs needing surgery and the option is not available. The anesthesiologist was on call at her own hospital that evening, and would need to return to Port au Prince immediately following the surgery (and she was too- she didn't wait till after recovery, she was dressed and beat the Dr. and I out the door!) After all arrangements had been made with the anesthesiologist and the small hospital down the road where the surgery would take place, Mother 1 was taken off the table and off the pit and placed in a bed to resume laboring on her own.

Mother 2 was by this time dilated to 7 and was placed on the delivery table. She too was augmented to speed things up and get her delivered before Monsieur had to leave for the surgery. I labored alongside her and within 2 hours she was complete and ready to push. Mother two was such a strong woman! She was a big, robust woman who embrassed each contraction and roared with every push! I have hardly seen such strong, effective pushes. She needed no 'coaching' from anyone. She was a fabulous pusher. After about an hour of pushing, she birthed a fine, fat, healthy boy. I prayed she would find comfort from the loss of her other child, and that this child would bring her peace and joy (not that one can replace the other, by any means). With Mother 2 barely off the birthing table and in bed with her baby beside her, we raced off to the hospital.

When we arrived, we quickly changed and entered the operating suite. It was the first time during this visit to experience air-conditioning- not the entire hospital, just the operating suite. (The patient ward was actually sweltering.) When we walked in the patient was on the table prepped for surgery, the anesthesiologist had already done her thing and the entire team was waiting for us. Monsieur introduced me, and everyone welcomed me. There was a scrub nurse, a circulating nurse, a first assistant (also a nurse, I learned later, trained by the Dr. himself- usually the first assistant is another physician, but there was no other physician), the anesthesiologist, and a dedicated baby nurse, who also acted as a second circulating nurse. The team worked beautifully together. The surgery was fast and effecient (it had to be, we had one other laboring patient to get back to!) I found it interesting that the baby nurse was handed and upside down baby, dangled by its feet, which she carried that way out of the operating suite to a nearby gurnee waiting with baby supplies on it. (There were no baby warmers or a fetal heart monitor in the hospital). She quickly cleaned and dressed the infant girl, and then left her there on the gurney (completely unattended!) and returned to finish helping with the surgery. She glanced out the operation room door, window every few minutes (as did I!) to make sure the baby was still safe on the gurney that had been pushed up against a wall. With the last stitch sewn, Monsieur and I fled out, just as quickly as we had come and drove back to the clinic. I thought the anesthesiologist might stay until the patient was out of recovery, but she was dressed and headed out the door ahead of us, even though she was still in the OR when we left it!

Back at the clinic, Mother 3, our youngest, and a primip, was hard at work laboring. She too went to the delivery table and was at almost 8. Even so, it took a couple of hours to become complete and a couple of more hours for her to push her baby out. She was a sweet girl and she really fought her pushes. She not only relished my labor assist, she would grab me around my waist with each contraction and bury her face in my bosom! I think if she could have climbed into my lap, she would have done so. She screamed with each contraction, but would also eventually bear down nicely. As with the other primip we saw this week, Monsieur cut an episiotomy. I thought with the other, the epis seemed a little 'crooked'. This time when he did the epis repair after the birth of a sweet little girl, I came around and stood next to him to watch, and sure enough, he had cut a medial lateral epis. I have not seen these done in a very long time- I winced to think of her recovery in this heat. By the time, she was recovered, cleaned up and tucked in bed, it was 10 o'clock at night. The first clinic patient had arrived around 8 am that morning. It had been a long, and as Monsieur had predicted, a very busy day. Sometime between Mother 3 being complete and pushing, he had returned to the hospital to check on Mother 1. All in a day's work for someone on the front line of maternity care.

I could hardly process all that had happened that day. I had to fall into bed, and be up for a 5 am ride to the airport. I had used snatches of time during the day to straighten my quarters, and pack my things. I went up to the Heart to Heart clinic to say my goodbyes. I wolfed down a dinner that might have been the best one yet. There was chicken cooked in a delicious sauce, that had been strutting around the yard this morning. "Monsieur!" I asked agast, "You mean this chicken was alive this morning?" "Yes," he answered proudly between mouthfuls, "this is fresh, organic chicken." I didn't ask about the details of his demise and preparation, all that I had missed with the busyness of the clinic. I didn't want to imagine Monsieur ringing a chicken's neck in between patient visits. Better to think the old housekeeper did it- she was stick thin, but strong and sturdy and has probably wrung more than a few necks in her lifetime. This 'fresh, organic' chicken was served along side beans and rice, and a Russian salad. This was a salad of cubed roasted beets and potatoes, like a potato salad made with half beets. Stirred together with mayonaisse (?) it made a pinkish unpalatable looking mass, but one taste and I was hooked. It was delicious! the roasted flavor of the beets was perfect with the boiled potatoes. I ate two servings and since no one spoke for the last little bit left in the bowl, I ate that too.

I was up the next morning at 4:30 am, packed, dressed, and ready to go. I used the final 30 minutes of my stay to sit quietly on my balcony and allow the morning to unfold. I took a few snapshots, that won't begin to tell the stories, or capture the beauty... Madam and the driver and I packed into the truck and headed for Port au Prince. I never dreamed it would take so long. We must have hit ''morning rush hour" in the city, because we moved at a snail's pace throught the densely packed corridors. The driver tried his best, honking all the way, even driving up on sidewalks (!) and narrowly missing pedestrians, who share the roadways equally with vehicles and animals. Even so, I missed my flight out to Ft. Lauderdale, and was rerouted on the next flight out, an hour later, into Miami.

My intent had been to rent a car in Ft. Lauderdale, and drive up the coast to Orlando. Arriving in Miami, they did not have a car for me, so I instead booked a flight to Orlando and rented a car once I arrived there. Once I arrived in Orlando, I drove to my hotel, and settled in for the night. I called Jennie Joseph, let her know I was in town, and made an appointment to meet with her the following morning.

Today I met with Jennie and spent the morning and afternoon with her. How can I relay the value of such a meeting? She gave me a tour of her birth center and clinic and we went out for a Cuban lunch. The value of the advice she gave me far outweighs the time and expense it took to get here to receive it. I feel so honored to build my life's work upon the foundation that women like Jennnie have built. I now have a perspective of my work that is not predicated upon my own singular successes or failures, but as a smaller part of a much larger work, much like a quilt where each piece contributes to the greatness of the whole. After what I have learned from Dr. Delson and Jennie Joseph, I return home with greater clarity and resolve to do the work that only I can, and must do.

I am reminded of the book of Esther. Who knows that I have been placed here for such a time as this? This is my time, I've long known it. I have one more day here before returning home. I've decided to make it a day of silence, prayer, and writing. There is much to be done.

Thursday, May 26, 2011


Yesterday, I sat on my balcony entertaining two guests. Kicki and Mose. Kicki was my interpreter during my first trip to Haiti last March, and Mose was my interpreter during the October trip. I introduce them to one another and watch a bond form. Like most interpreters, they are in their early twenties, and hope for a better future. I smile watching them converse in Kreyol. While Mose lives and works here in Leogone, Kicki has made the trip out from Port au Prince to visit with me. I have seen Kicki on every trip, he has been generous, keeping in touch. I fuss over them both, telling them how handsome and how smart they both are. Kicki smiles shyly and tells me he is too 'flat' (he means he is skinny!). Mose says his English is not good. "No", I say, "it is very good!" (It is far better than my Kreyol.) We visit for a long while, and I hear about their families. Kicki plans to start college soon. He has been waiting and saving for four years to go. I am thrilled for him. He is torn between studying engineering and architecture. Kicki has written a book and shares it with Mose. He has written two volumes of a book on French to English translation. I look it over and it is very well done. He spells out the pronounciation of English words from a French linquistic point of view. I've not seen anything like it. I have had trouble learning Kreyol from a book because looking at how a word is spelled, does not tell me how it sounds. Kicki has already corrected me for pronouncing Kreyol words with a Spanish accent. (Spanish is the language I know best after English, and it does get in the way of both my French and Kreyol. When I think of a word I want to say, I have to sift through it's English and Spanish counterparts first in my brain.) Kicki is very bright and I know he will do wonderful things with his life. He will make a very lovely man, inside and out.

The theme of the day must be visiting, because after clinic is completed for the day, I walk down the road and visit at the Heart to Heart clinic. There are six workers at the clinic lodging house, four from the US, one from Dubai, and one from Mexico. I enjoy a nice visit with them. They all plan to go to visit Nicole's orphanage tonight. I cannot go because there is a mother in early labor and I don't wish to miss it.

Madam prepared a thick bean soup with beef and plantain (which taken on the texture and taste of potatoes when cooked this way) for dinner. It is delicious. Gigi has dinner with me, and has four servings- in between making faces at me, and shooting me with his finger gun. I feign a hideous death for his amusement. Gigi is such a little ray of sunshine. He plays all day long in between his parents working in the clinic. He can be seen tossing his teddy bear around the courtyard, or riding is toy motorcyle in the waiting room, or landing a toy airplane on the head of the washerwoman as she tends the laundry. The entire compound is his playroom, and all the adults adore him. His parents especially. His mother rarely scolds him, and he brings a ready smile to his father's face everytime he catches a glimpse of him. Wherever I am, I hear his little four year old voice, singing songs, or calling out for his mother. It won't be the same around the clinic when he joins his brother and sister at bording school next term.

Last night I had a full night's sleep. The laboring mother came last night into the compound, but she was still laboring this morning- along with two others! I woke with a start, thinking I had missed the birth, but when I came down for breakfast, I found her and two others pacing the clinic floor in their nightgowns. Monseiur tells me it will be a busy day. I am glad, since today is my last full day in the clinic. I leave at 5am tomorrow to catch my plane in Port au Prince. I will spend the weekend in Orlando discussing birth centers. I am wistful today, as it is my son, William's birthday. I know the entire family will go to Mi Ranchito tonight for dinner, our family tradition. I'm sad to miss it because the birthday person has to wear a rather large sombrero while the waiters sing to him/her in Spanish! We all laugh at the afflicted one, take pictures with our phones and post them on facebook. What can I say? Its a tradition. I'm also a little sad because William will be the first of our children to leave Kansas City after leaving home. He plans to move to Denver in a couple of weeks. I'm not sure when I'll next share a birthday with him.

As my time here comes to a close, I think of how I have fallen into the flow of life here, and its predictable patterns. The Haitians go to bed early and rise early (as is my custom). I am amazed by the humility and generosity of my hosts. The thick, wet heat has not bothered me much. I enjoy the daily afternoon rain shower, and the siesta it brings in the middle of the day. I have not had a drop of processed food all week. I have lived as a Haitian, without the usual worries of a visiting foreigner. All has been well. Thanks to those who read these posts, and give me an audience for my reflections.

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.

Monday, May 23, 2011

Big Pharm or Big Phuck?

Today I spent with Monseiur in his clinic. The patients started early and stopped coming at midday during the heat of the day, then they resumed coming in the late afternoon. We saw two patients today who were coming after self-induced abortions after taking cytotec. Apparently this was not unusual. I asked Monseiur where these women would get cytotec. He said from the pharmacy, they can just walk in and purchase it. I had no idea. I asked him if the women ever had complications from it. He said sometimes he had to do a D&C but not often. I asked them how much they took. The first patient today coming in for this reason had swallowed two pills and placed one in her vagina! (This is a much greater dose than is given for induction or even postpartum hemorrhage, but I don't know the protocols for abortions.) Monsieur did ultrasounds on both women to see if all had been expelled. I asked him later what Haitian women did for birth control, not knowing what answer I would get in such a Catholic country. He said that they preferred birth control pills and depo. We saw several women for prenatal visits and women of all ages for GYN concerns as well. In all Monsieur saw about 35 patients today.

After the postabortion patients, the patients I found most interesting were for HPV follow ups. Monseiur explained that he had particpated in a drug study with one of the big pharmaceuticals that involved screening 10,000 Haitian women for HPV. When the results were returned, the drug company asked physicians to biopsy (take a tissue sample) all the women whose tests came back positive. Monseiur refused. He would only biopsy those who showed abnormal cervical tissue on a colposcopic exam at follow up. He was not going to biopsy healthy tissue. This started a day long dialog about the exploitation of third world women by drug companies, NGOs and even charitible and religious organizations. I knew all too well what he meant. Hadn't I myself many times particpated in the ''treat 'em and street 'em" brand of healthcare both at home and abroad? This company was not offering treatment to the women who tested positive, only a testing of their screening product. This whole conversation got my blood boiling- again. Monsieur told me at length how again and again he had entered into agreements with individuals and organizations that promised this or that but in time, they all leave. Here he remains, carrying on the work that must be done.

My time here becomes clearer as the days pass. Monseiur exemplifies that model of care that I want to emulate: long term solutions rather than half-assed quick fixes. Later that afternoon, during the break in the heat of the day, I walked down the dirt road to the Heart to Heart Clinic. This is where I had worked when I was here last October. In the courtyard under a shade tree, I immediately saw Wilifred, and Mose. I hugged them heartily. I didn't know it would feel so good seeing my interpreters again looking sturdy and handsome. They smiled and hugged me back. Then I went inside the house to say hello. I recognized the cook and greeted her, and then greeted the two individuals at the table. One was a Haitian whose job was to look after the house, the other was Nicole. We had not previously met. I introduced myself, and we each shared what we were doing in Haiti. She and a friend had actually rented a house for a year here in Leogone with the intention to start a charity/NGO to serve the HIV population. I shared my plans with her for my urban birth center. We walked a bit, and I introduced her to Dr. Delson. He made it plain he had no interest in her ideas. I, however, hope she gets to do all that she intends and more.

Dinner last night was a savory blend of rice and beans, green beans, and stewed conch and onions. I had not had this kind of seafood before but it reminded me of squid in its appearance, but was softer in texture. I enjoyed it very much. After dinner the clouds moved in. I was breathing a prayer of gratitude for the rain after a hot dusty day, when I remembered the poor souls in the tents across the roadway. I peeked out my door across at them, but I could see nothing- pitch black- there was no electricity tonight. We had some because of the back up generator, but elsewhere in the neighborhood, there was pitch blackness all around. I tried to imagine what it must be like in one of those tents, with the heavy rains coming down and sitting in the dark. I thought better of giving thanks for the rain, when I was warm and dry and had light to read by.

I stayed up reading for several hours until I heard Monsieur coming up the stairs calling my name. "Oui? Monsieur" I called out, wondering if he was coming to tell me the state electricity was back on. I had been sitting in the bathroom reading in poor light because my bedroom light and fan had no electrical current at all. Better, a woman had arrived in labor! She was dilated to six with baby number three. When I freshened up and arrived in the clinic (thank goodness I had not changed out of my clothes for the day yet), she was already on the delivery table with her legs in stirrups. I was surprised to see he had her laboring in that position. Her broke her water soon after I arrived, it was nice and clear. He ran back and forth, between the mother and his generator (he had workmen working on trying to get more electrical coverage- the delivery room had lights, but he was trying to get the fan going as well) I was able to give comfort care such as it was. I put a pillow under her head, a cool cloth on her forehead, and fanned her with a packet of sterile gloves. I soothed her with my minimal command of Kreyol. Her husband and two kinswomen waiting out in the waiting area, but every now and then, her nervous husband would stick his head in the door to see if she was alright. His anxious face made me smile, surely nervous husbands the world over have the exact same look. I smiled at him as I held his wife's hand to give him some reassurance. I wanted badly to wave him in let him hold her hand instead, but I have not seen this be the custom in Haiti, and I was determined to just observe (though by getting up and helping the mother I had already broken that deal with myself) and see how Monsieur does things without intervening. While I might later suggest this or that (if it is appropriate), for the first delivery I thought it best just to see what actually occurs in the course of a delivery here. The woman actually labored fine before her water was broke, but the contractions became noticably more intense afterward. With each contraction she would grab me around my waist and look into my eyes. I wished I spoke her language so I could comfort her better, instead I just returned her gaze and slowly shook my head yes, as if to say, "All is as it should be, all is well." As Monseiur predicted, she did not labor long. Within the hour after I arrived and her water was broken, she pushed out a fat juicy baby girl with a fat robust cord, wrapped loosely around her neck and a compound presentation as her head emerged along with one arm. I was surprised to see Monsieur dangle the infant by its feet, yet he was gentle and I saw fluids flow from her mouth. He never suctioned her, she never cried. She only looked around wide eyed and alert. Madam appeared to claim the baby. She never bathed her, but wiped her down, weighed her and dressed her in the diaper and clothing the family had brought for her. She was still covered in vernix, but all the blood and fluids had been wiped off. Madam then took the baby into the recovering room where the Father and two women waited. Monsieur had to do stitches and I assisted and observed. There was really not much for me to do since Monsieur was not used to working with a nurse assisting (even though Madam is a nurse- she did not help at all with the delivery and only appeared to care for the baby) so he pretty much did all the tasks I would have done. However, he did explain what he was doing to me. Then Madam came back and cleaned the mother up and we helped her walk into the next room where her baby and family were waiting. It was as calm and as simple a delivery I had seen in a medicalized setting. Madam and Monsieur hardly spoke, except to give a few directives. (Monsieur was actually much more animated about the generator situation.) I helped Madam clean up after the delivery. There was a lot of amniotic fluid, most of which came as baby was pushed out. The mother had recieved 10 units of pit in a IV Monsieur had started when she arrived. After she was in bed, he also gave her a cytotec pill to swallow with water. I asked Monsieur how long they would stay. He said about six hours, that they would leave in the morning. Sure enough, when I came down to breakfast, they were gone.

Chicken Culture

Last night after the Merisiers returned, minus two children, we had a fine dinner of okra and beef neckbone stew (I had never eaten okra before and in truth may never do so again, but it was quite delicious), and rice cooked with tiny beans (the size of cooked millet or bulgar wheat) that I had never seen before, but it too was delicious. More frozen papaya juice rounded out the meal.

After my trip back from Port au Prince, I have decided to alter my appearance. I noted on previous trips here that I could pass for a Haitian except for one thing: my hair. After studying intently, I have noticed no Haitian women wear their hair as I wear mine, in a short Afro. They have processed hair, or if it is natural, it is in braids or cornrows. I also brought along a head wrap, but I noticed that the Haitian women don't wear updo headwraps as African women might, but lowlying wraps that hang low instead of pile high. I also noticed that my Afro was not faring well in the dust. Typically I can wash my hair once or twice a week and it maintains its smooth shininess and shape. Here after one day it was dull, misshappen and wild. I decided I will be Haitian, and wear braids. I had to borrow a comb from Madam, wash my hair about three times to get it clean, than comb it out and braid it. I'm afraid I am no longer very good at braiding since I have long since stopped braiding my girls' hair. I look rather like one of Monsier's chickens, but I also look more Haitian.

Unlike the sleep of the dead I experienced last night, due to my extreme fatigue, this night was fitful. The mosquitoes nearly devored me. I wonder if last night, I was too tired to feel them biting me. The first night I also closed my front door, last night I kept it open to give me more of a breeze- it only gave me more mosquitoes. I also discovered a trail of ants- making their way over to and into my bag of trail mix. I poured it all out on the bed and shook loose the ants, and rebagged it. I have no intention of going all week without a protein snack. The other disturbance to my sleep was the music. It just so happens their is a discoteque directly across the road from my quarters. The Paradise to be exact. It is really just a walled in compound with concrete slabs for floors and thatched rooves overhead (same construction as the local churches) I'm sure the music and revelers were just as loud the night before last, but I did not hear them. Tonight, I was treated to an eclectic variety of Reggae, American and Haitian hiphop, sad French love songs, and Justin Bieber (?). The music was very loud, but that didn't bother nearly as much as the drunken revelers who became more verbose as the evening wore on. Their numbers had grown so great, they spilled out of the Paradise and into the street directly under my windows. Finally it all stopped, and the night sounds of Haiti took over. While human voices and noises rule the day, animal ones rule the night. Monseiur's seemingly nocturnal roosters, begin their calls around 3am- just shortly after Paradise shut down for the night. How did I not hear any of this the night before? Add to the roosters; dogs barking, and cows lowing and you get a more complete picture of my constant auditory assault. Even so, I did manage to get some sleep, but I woke several times to commit mosquito massacre and spray repellant on my beseiged ankles and legs. I dreamed of malaria all night. On a good note, once morning broke, I sat out on my little balcony to listen to the call to prayer coming from the Sri Lankan camp down the road. It was the sweetest sound of the assault of sounds I had heard all night, and made me once again grateful for the gift of sound.

Before breakfast, I went with Monsieur to feed the chickens. As he fed them, he gave me a primer on chicken culture. He alerted me to the sounds a chicken makes when it has laid its eggs. (He then went through the thicket in search of the eggs). When I saw a loose chicken seem as though it might get into a cage with the hen and chicks, I alerted Monseiur. He simply shrugged his shoulders and said, "He won't go in, if he does she will kill him." He pointed out two young roosters sparing with one another, stretching their necks and spacing out their feathers until the look like ostriches. They never fight, only posture and threaten. At this point, I feel that I have learned more about chickens than I have about women, birth, and babies. Yet the lesson is not lost on me.

We show even less sense than Monseiur's chickens. The chickens know that a hen and her chicks must be left undisturbed. But we bombard our new mothers with unreasonable expectations, from knowing 'instinctively' how to care for her infant, to getting her figure back quickly, to returning to work in six weeks ready or not. We allow visitors to converge on an exhausted mother and expect her to entertain them in her dimished state. We tell her that breastfeeding will come 'naturally' and leave her to find her sorority of mothers as best she can. Professionals offer opposing advise to that received from mothers, grandmothers, and aunts, leaving the new mother bewildered and unsure of whom to believe. Other cultures are far more protective of new mothers than we are. Even chickens understand the importance of this.

Sunday, May 22, 2011

Becoming Haitian

After many mishaps (including a cancelled flight and a 12 hour wait for the next one) I finally arrived in my beloved Ayiti. When I arrived at the airport tired, from a night without sleep (from sitting up in an airport) and being crushed in a small airplane seat for hours, I felt so good to finally touch down. There were my mountains (ever constant!) waiting for me. Dr. Delson and his driver, Francios arrived shortly after I emerged from Toussant L'Ouveture airport into the hot, crowded outdoor waiting area. The hour and a half drive back to Leogone seemed shorter, since I slept through most of it. I thought I might have my old room back again, but Dr. Delson ushered me to my new quarters, a small second floor apartment that was being built the last time I was here. I entered my small neat quarters with an attached bath and saw how hard the Merisiers had worked to secure my comforts. Dr. Delson pointed to a self standing air conditioning unit in the corner of the room. "It doesn't work" he apologized, "not enough electricity to run it." He had purchased two of them and installed the second in his and Mrs. Merisier's bedroom, but without electricity enough to run either. In truth, I was glad. Though the heat was oppressive to some visitors, I handled it well enough. After all, the hot wet heavy air is reminiscent of my midwest home. "Dr. Delson", I assured him, "When I am in Haiti, I will be Haitian."

Upon my arrival, I greeted Madam Merisier and the three children and gave them all gifts. Madam recieved sturdy cooking utensils, the oldest boy of eight I gave a toy airplane, Delshawna, the six year old girl got a purse with a stuffed cat in it, and to four year old Junior, whom everyone affectionately called, Gigi, I presented a pack of tonka trucks. I also handed Monsieur the money for my room and board for the week, which he promptly handed (without counting) to Madam.

On the ride back from the airport, Francios produced a bag of sandwiches. I was hungry, but disappointed to see the bag held a hamburger and fries (the Haitian version of which is far from palatable). I was hoping for some Haitian delicacy. I munched a couple of fries to be polite, and downed a bottle of water instead.

However, after arriving at the clinic (serving as the family temporary home as well), I showered, changed and came down to dinner to a real Haitian meal. Madam Merisier did not dissapoint. She served rice over which was generously poured a rich, succulent bean gravy. This was served alongside a hearty stew of carrots, greens and beef. I can taste it, even as I write. This was the stuff for feeding a weary sojourner. Alongside was served a cherry drink, made from the Merisier's own cherry tree, that was thick and delicious and had the consistancy of a slushy. This theme of consuming what they themselves had grown, or raised and slaughtered was to continue.

After dinner, Monsieur (Dr. Delson) asked if I would like to accompany him on his favorite end of the day activity. The children followed along as we walked a short way up the road to the plot of land where is house once stood. He unlocked and pushed open the gate, and an entire HERD (yes I know chickens come in flocks, but they came at us like a herd!) of chickens came clammoring towards us. Monsier laughed and said, "They know it is time to eat." There must have been about 50 chickens in the yard. A small white chicken even jumped into his arms, not waiting for him to lower the bowl of feed to the ground. Monsier smiled again, "She always does that." I watched as he went patiently about, feeding his chickens and telling me how he had figured out to breed chickens so successfully. He kept the hens with chicks caged at all times, because he found left loose at night, they were killed by 'rats, snakes, and mongooses'. He also discovered that given them medication at certain times of the year kept them from succombing to infectious disease. At night, all the chickens retreated to their pens to be locked in for the night, and the four dogs living on the property, were let loose (as they were penned by day), to discourage theives or mongooses who might try to get at the chickens. There was also a tom and hen turkey among the chickens. Monsier, had hoped for some baby turkeys, but the latest nest had, 'gone bad'. The hen turkey was kept penned so that she would not return to sit on the doomed nest. Monsier grabbed the tom turkey and put him in the pen with the hen, saying, "Now, go to her" betraying some wish that soon there might be a new nest.

Afterwards, we walked to the back of the property to feed the goats. I did not know the property went back so far (the foliage is so heavy) but as we walked, we passed not only the eery tangled metal remains of the Merisier house, but two other houses as well! "Monsier," I asked, whose houses are these?" They belonged to his brother and sister, 'for retirement' as they both live in the United States. I marvelled once again at how much he had lost and yet he remained resolutely upbeat. I was learning more about Dr. Delson in one day on this trip, than I had known the entire week previously.

I began to ask him about his practice. He said he was the only OB in Leogone, but that he had lost much business since the earthquake when the NGOs and missionary clinics came and served the women for free. He said this matter of factly without malice about the loss of income. He said that before the earthquake, he had a pediatrician partner (the clinic was two floors then) and they had planned to practice full service maternity and pediatrics together. After the earthquake he not only lost his newly built two story home (completely built but not yet painted), but his partner went in search of other opportunities elswhere. He told me Leogone has always been his home and that the need is great, and that someone must stay to serve. When I expressed astonishment at all he had lost, he shrugged his shoulders and said, "I am glad to have my life, that and my family's."

After feeding the goats, he showed me the fruit trees on his property, mango and papaya mostly. Then he asked me, "Have you ever heard of breadfruit?" "Yes, I've heard of it, but I've never eaten it." "This is it." He held out a strange roundish spikey green thing, presently pulling it open with his fingers to reveal its pulpy flesh. I picked some up and almost put it to my mouth but the youngest child laughed at me. "Here is the part you eat," Monsier quickly showed me as he held out a round hard pingpong sized seed pulled deep from within the flesh. "Oh, you eat the seeds?" I asked. "When they have been boiled." Then he pulled several breadfruit from the tree and we all retrieved the 10-12 seeds from each one. "These are small ones," he said, "the larger ones can have up to 50 seeds in them." When we had walked back to the clinic, he gave the bowl of breadfruit to his wife to cook. "You will have them for breakfast," he said to me, "then you will be just like a Haitian."

He told me at one point (while I was devouring his wife's cooking), "We are family now" and I believe that we are. At one point he mentioned that he had never done an abortion even though he had been asked to many times. "Why is that?" I asked, thinking it had something to do with the Catholicism of the island. "I just cannot do it," he finally said after trying to explain. I understood, I could not with my own hands either. The conversation turned to brighter things as he told me about how he had lowered the rate of preeclampsia in his community and helped to stem the flow of maternal deaths. "Dr. Delson," I said, "I shall make a study of you." "I want to write about what you do here, and publish it in a medical/nursing journal if I can. "

This morning, I enjoyed a breakfast of fresh bananas, and mangos, papaya juice (again frozen and slushy and delicious, and made from their own papayas), breadfruit and Haitian coffee. Now when I saw the coffee, I did not want to have any because I am not a coffee drinker. Besides, it looked blacker than American coffee which I took to mean it was even more bitter in flavor. I poured a cup to be polite, and much to my delight, the stuff was delicious! Sweet, smooth and more flavorful than I can tell. I drank two cups! The breadfruit, alas, did not fare as well. They had been boiled and peeled, and did indeed did have a flavor reminiscent of bread. The texture was soft and fleshy, but the flavor somewhat stringent and unappealing. I ate several, again to be polite, and chewed them alongside the banana to mask the flavor.

Francois took me back to the airport to retrieve my missing luggage (Monsier's luggage to be precise, it was his medical supplies). That done, I returned to my upper room retreat to nap away the hottest part of the day. The Mercier's had gone for the day to a party in Port au Prince and to return their two older children to boarding school for the week. I look forward to what the rest of the week holds. Monsier said he has four women due anytime, so perhaps that fates shall shine upon me.

Tuesday, May 3, 2011

Sex Slave

Yesterday, I was following a lactation consultant as a part of my studies. She was doing her usual round of seeing new mothers and helping them get their babies on the breast, when we received a page to go to the pediatric clinic. This was not too unusual. She often received pages from the pediatricians in the clinic when they had new moms back for baby weights or infant exams and there were breastfeeding issues. So we finished up with the patient we were seeing on the unit, and headed down to the clinic.

When we arrived, I immediately recognized the patient as someone I saw last week, when she was still an inpatient. I remembered her well because she had had a fourth degree tear and could not sit without discomfort. This time the father of her baby was with her, and I immediately began to get 'a dark and sinister vibe'. The young mother, in her early 20s was obviously from some eastern European country from her accent, and the 'father' was in his late 40s, early 50s, American, and from a part of town known mainly for its gross of per capita meth labs. If the whole look of it didn't freak me out enough, the young girl was visibly shaking the entire time we were in the room. I've seen lots of nervous new moms, but her hands were visibly shaking with fear as the lactation consultant helped her nurse her baby.

Horrible, terrible thoughts went through my mind. Thoughts like, "Where is this girl from and why is she with this old man?" "Is she with him willingly?" "Has she been forced?"
But it got worse.

After the visit, the lactation consultant responded to my many questions. The girl appeared to be a 'Russian mail order bride" except there were no wedding rings (I looked) and I didn't believe she was from Russia (Belarus or Romania perhaps). The couple had an open social service case due to 'perineal bruising' discovered during prenatal care. Nursing staff had charted her unusual appearance when she came for care: pigtails with cropped tops and short shorts in advanced pregancy. All this information made me sick to my stomach. I wish I hadn't asked.

The lactation consultant thought the girl was to be discharged to a women's shelter when she left the hospital and was surprised to see her going home with the father of the baby. She made another follow up appointment to 'keep an eye on her' though the breastfeeding was improving. I'm still shaken by this encounter. Horrible thoughts about this girl invade my mind. I know help has been offered, but she has yet to take it. The pediatric visits will soon end, and so too may the social service case. If help doesn't come to this girl and her baby soon, it may not come.

I know a little about human trafficking because my son did a summer intership with an organizations that works to eradicate it. I also know that I live in a medium sized city with a very diverse population and that its location is a crossroads for the entire country. I know that drugs move through my city at an alarming rate, and that there are people here who are poor and desperate. What I didn't know was that during the course of a regular work day, I would cross paths with a woman who was very likely a victim of human trafficking in the sex trade- and that I would feel so helpless as to what to do about it.

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