The Hospital. Part One:
It’s my second day in Haiti. I already have the wonderful, earthy smells and thick heat of Haiti under my fingernails. I’m also covered in mosquito repellant but haven’t seen a single buzzing pest since arriving from London the previous evening.
After lunch, Nadene and Steve (the directors and very lovely people) and I head over to Hospital Ste. Therese. Since we are going to our clinical site and are known there, I’m advised to put on scrubs. I’m very pleased with how I look in scrubs; I’ve got some past experience as a student midwife and, in these blue scrubs, I’m “playing midwife.” Little do I know that my butt will soon be kicked.
We are at the hospital so that I can tour the facilities but so that we can also figure out what we can improve and, consequently, what we will need to fundraise for.
Midwives For Haiti recently started a Postpartum Clinic and the response has been overwhelming. Prior to this program, only 1% of women delivering at the hospital received postpartum care for themselves or their baby. This means that mothers would take home sick babies or healthy babies that would become sick later or that mothers would have complications (many died) once they went home… all because there wasn’t a midwife to evaluate mom and baby before being discharged and to do education on signs of complications or reasons to return for care. Commonly, after a normal vaginal delivery, mom and baby would be going home after only 4 hours with no follow up. Obviously, this didn’t go well for many moms and babies, hence the inception of the Postnatal Clinic. Since the program started in July, nearly 900 women have been seen and many, many bad outcomes have been avoided.
The Maternity Center at Hospital St. Therese is comprised of four rooms: antenatal, post-op, and postpartum. Plus, Labor and Delivery. Today, the three former rooms are all mixed, but about 80% of the beds are postpartum or post-op patients. The two Postnatal Clinic midwives, Illa and Juslene, are busy tending to the patients. We start following them, inquiring about the patients they are caring for. One patient had had a postpartum hemmorhage that they discovered and managed today. If they weren’t here, who would see that and control her bleeding? They show us a few babies they are caring for and the charts from their deliveries. Sweat is pouring off them in this busy room. There are no fans.
I am taking pictures of the conditions of the rooms- it’s pretty rundown, absolutely no “amenities”- though I am wishing I could photograph some of the moms and babies. If I could take pictures and show you the experience of these new mothers, TRUST ME YOU WOULD BE REACHING DEEP INTO YOUR POCKETS. For this reason, I don’t take the pictures. I don’t want to make a spectacle of these vulnerable, newly delivered women and their sweet babies, who are covered in flies as relatives try to shoo them away while also caring for the mother.
Here, you must bring a bucket for your own delivery fluids and all your own waste. You must bring your own sheets, your own food. If you don’t have a relative to care for you or feed you, you are out of luck. At night, relatives must sleep on the dirty floor.
There is a very young mother who has twins, she is spacey and seems to be having a very difficult time. A grandmother very proudly holds her grandchild while her daughter sleeps. There are a couple women lying alone, no longer pregnant and with no babies in sight. One woman is half naked moaning in pain and I can see her cesarean bandage. We go to another room and then another… open rooms with about 10-15 beds each, all filled, and it is more of the same. Mothers look at me in my scrubs with eyes that say “DO SOMETHING TO HELP ME!” but I have nothing to offer. I take more pictures of the rooms.
We are going to ask our supporters to help us improve the postnatal clinic by hiring additional auxiliary midwives- two women alone seeing nearly NINE HUNDRED patients in a few months is not enough support. These rooms need to be improved so the midwives can do their jobs better- we need supply cabinets, improved work stations, more materials. And then of course, we want ceiling fans and screens and bug zappers to keep mosquitoes and flies off the moms and babies.
We stop at a new NICU, a project of Ohio State University. They got a massive grant to build this facility in an old storage closet. It is AMAZING. The room is sealed shut with a glass door, it is air conditioned, sterile and clean, and there are several incubators with tiny babies. The NICU nurses had over nine months of specialty training and there is an MD there now, teaching. They are keeping babies born as early as 29 weeks alive. In Haiti. This is mind boggling. This is the best NICU in all of Haiti, and it’s one door down from a room of 20 new mothers on dirty bed sheets with flies on their newborns.
On to Labor and Delivery. The room is divided by three partitions. Three women in various stages of labor are here. There is no midwife present. One woman is laboring hard and moaning. My inner doula comes out and I am touching her back and trying to help her breathe. I am speaking to her in English and she is speaking to me in Creole. Oui oui oui, I am saying, let it come. She is having a hard time. The woman next to this one is flat on her back, naked, feet in the stirrups, absolutely quiet. The third woman is half way behind a curtain but I can see her naked on her back with blood all over the floor. Still no sight of a midwife. WHAT THE F*#% IS GOING ON HERE? Steve and Nadene are in the hall and I can’t leave this laboring woman yet and I am waiting for the midwife to return to figure out what is happening with this bleeding woman. She does return soon and tells me but I have no translator with me so all I can surmise is that the silent woman on her back is 9 centimeters dilated. I walk outside and grab a guy who speaks crappy English and ask him to interpret. The bleeding woman had a miscarriage. The laboring woman has yet to be checked. The 9cm woman is just waiting on her back.
Meanwhile, visitors to these naked patients –including myself- just walk in and out. There is no privacy except for the half closed partitions.
Since the midwife is back, we continue our tour of the hospital. Every room we pass seems to be more grim than the last. Pediatrics, the ER, the Intensive Care Unit. I literally cannot look into the rooms because it feels disrespectful.
I do see a few Haitian doctors. I do see many family members waiting to take care of their sick relative. I do see many fathers holding terribly, terribly sick children. Nadene can see that I am struggling and asks if I’m okay? Of course I am not okay.
We swing back one more time to L/D to check on the situation. The blood has been wiped from the floor and seems to be controlled. The laboring woman has been assessed and is 6cm dilated. The other woman is still waiting I guess.
It’s pretty obvious- we need more skilled birth attendants on shifts. We need managers to ensure everyone is receiving the care they need and deserve. We must improve the condition of these facilities. We must give these mothers and babies more. And none of this, as far as MFH can tell, will come from an underfunded and resource strapped government. So here we go.
The Hospital. Part Two:
It’s 8:15 in the morning and I am on the back of a motorcycle between the driver and our best translator, Emmanuel. We drive a few minutes to Hospital Ste. Therese, where throngs of people wait outside the hospital. It is a busy place.
I am here to talk to our Postnatal Clinic midwives, Illa and Juslene. To take pictures of them working and hopefully speak to a few mothers who have received their care. Their shift started at 8am and they’ll be here until 4pm. They work this shift six days a week.
I immediately notice a difference from my last visit here. Our students -in pink scrubs- and our preceptors are everywhere. I count six students, three preceptors, plus a few nurse-midwives employed by the hospital. Each room is filled with patients at various stages of postpartum recovery. A few are still pregnant. But there are skilled providers and students there to care for them.
I am so encouraged. This is why our training program is significant for this hospital. Before MFH began working here, very few women came to deliver at the hospital. If you arrived between the hours of 4pm-8am there was absolutely no one to take care of you or give you the medicine you need to, say, stop your pregnancy-induced seizures (eclampsia is the biggest killer of women here). Now we staff the hospital to ensure care 24/7. Over the years, word spread that our students and midwives are here. So women come; last month alone over 250 women gave birth here. Not because they will get a “nice birthing experience,” although we are teaching the midwifery model of care which embodies compassion and kindness. They come because they know they have a better chance of not dying. For this, huge improvements have been made.
The morning is buzzing. I find Illa and Juslene in the entryway to the L/D. There are three women lying on sheets on the floor. One has a newborn, born last night. The other two have delivered but have no babies. This is the overflow from the postpartum rooms; there aren’t enough beds.
Illa is checking on one woman without a baby. My translator tells me that she had a stillbirth last night. She was 8 months pregnant. Her vitals and bleeding are fine.
Juslene is evaluating a mother and newborn on the floor. She is doing education- nutrition, danger signs, breastfeeding, family planning- as she talks. She emanates kindness and competence.
I am only taking pictures of the midwives work. But then I ask if I can take a picture of this mom and her baby. I am pushing the boundary, I know I am, but I need pictures of the patients who are benefiting from this program. I can tell Emmanuel does not approve but he asks anyway. She says yes (of course she does, I feel so dirty). I take a few and show her the digital image.
Juslene does a newborn exam and checks the mom’s uterus, which is healthy and shrinking. She says that both mom and baby are doing well and will be discharged now. She writes a free prescription for vitamins, pain medication, antibiotics to prevent infection from her laceration and sutures. The mother is given an appointment to return in a week. I take a picture of Juslene, the mother, the grandmother (who was there to care for her), and the newborn.
I continue to follow Juselene and Illa. They see many patients. They do not stop working. It is hot in the rooms and they wipe sweat from their faces but they never stop.
Before this program, only 1% of moms received this kind of postpartum care and education. That’s about 21 patients the entire year. Since hiring and training these two auxiliary-midwives, they’ve provided care to 894 women and babies in three months. They’ve increased access to care to 65% in 3 months!. It’s astonishing what they’ve accomplished.
I ask Illa what she needs here to do her job better. She thinks for a half second: two more rooms dedicated only to postpartum, a digital blood pressure cuff, more folders. She is going to think more and give me a list. We both laugh.
Emmanuel is called away to an important meeting between Nadene and the hospital administrator; we need permission to make improvements. I visit L/D. Four women are soon to deliver. Genette, our best midwife and preceptor, is teaching students how to place an IV. There are three students, one preceptor, and two nurse-midwives (paid by the hospital) here for these four women. I am pleased.
I have no translator now so I float around. Illa shows me that her manual blood pressure cuff is now broken. She and Juslene take turns with the only functioning cuff.
Juslene and Illa motion to me at various points to follow them. I take pictures of them working. Illa takes a full newborn assessment. She’s a pro. Then the mother is examined. The head nurse-midwife (paid by the hospital) sees my camera and does not want me to take a picture of Illa working with this family because the mattress is on the floor. No problem, I say, no pictures. Illa teaches the mother how to breastfeed. Everyone is happy.
I see the mother of twins from two days ago. She is smiling now and trying to breastfeed one baby. I watch the joy on the face of a first time mother looking at her baby girl. Many mothers lay quietly. I see big sisters or cousins holding tiny babies so gently. Babies are crying; it’s a wonderful sound.
Emmanuel and Nadene are back. The meeting was cut short because of an accident at a local school. A bulldozer drove by the school and shook the ground. Students, thinking it was another big earthquake, stampeded out of the school. Many students were hurt and are here for emergency care.
We cross the courtyard to the prenatal care clinic. The postpartum midwives use one of the rooms two days a week for the very important 1-week and 1-month follow up visits. We have to squeeze through the building hallway. There are pregnant moms everywhere, I can barely pass through. It’s a drop-in clinic so these moms can wait several hours for their prenatal visit. There are so many people in such a small space that it feels like I am in a sweaty club but with no dancing, no music, and no cocktails.
We manage to get into the actual room that the Postpartum midwives use on Mondays and Wednesdays. A preceptor is teaching four MFH students how to hear the fetal heart tones of a pregnant mother. The room is 4ft x 6ft. We are in the way so we squeeze back out. We walk to the side of the building and wonder if we can fit a pre-fab shipping container next to the building. Adding space here, like Illa said, is essential.
Back at the house, we send a moto driver to deliver a new blood pressure cuff for Illa. I begin outlining our fundraising plan; there has never been a more worthy project and I’m thrilled to help expand this program: to support the midwives and increase access to care is a relatively small task so long as we can raise the money, but the potential is profound. What really humbles me is the ripple effect for the mothers and infants who receive this critical postnatal care: some have very literally avoided terrible outcomes but all have been empowered by the education they’ve received. The many lives that are improved every day by this program are worth every cent of investment.
– Summer Aronson, Communications and Marketing Director, Midwives For Haiti