“You are going to see the real Haiti”, they told me.
So here I am in Cabestor. Beautiful, lush, green farmland. Trees. Friendly people. Super sweet kids. Farm animals everywhere. Motos. Kompa music and Creole voices calling out, laughing, singing. Roosters crowing. I think this will be an amazing two weeks.
The Birth Center in Cabestor is a lovely 2 story building with three big bedrooms and a bathroom upstairs for midwives, students, translators, and volunteers. Downstairs is the birthing room, with 2 beds for labor patients, and a bigger room where postpartum patients can stay with their babies until they are ready to go home. These rooms also double as clinic space Monday to Friday, with the midwives juggling multiple functions and patients seamlessly, and with great poise. This extends to those times when patients are staying overnight, and the Haitian midwives sleep downstairs to be close to any one in need at any time, rising to the occasion (literally) in their jammies and night caps. Adjoining is an office with exam table and supplies, and a small “pharmacy” in a storage closet. Long porches wrap around much of the building, the big veranda downstairs serving as a waiting area and classroom for clinic patients.
Today we saw about a dozen pregnant women, and several moms returning for follow-up with their new babies. Every clinic opens with an education session, and is usually run in a “group prenatal” format. The rest of the morning is fast-paced as we check vital signs, weigh, measure, and evaluate bellies and babies. I am so thankful for all those years of practicing midwifery without routine ultrasound- and so happy to put those hand skills to work assessing presentation, position, gestational age, and interval growth. Two babies were born in the afternoon, about an hour apart. We have a *lot* of babies due between now and the end of September!
This day wraps up with one of the midwives, Miss Nelta, sitting at a small table out under the mango tree, and suturing a hand wound on a very young woman. It looks like a kitchen accident to me
(possibly a machete?) and is a significant injury. I hold a head lamp for her as night falls and she completes the repair. I have no doubt she would have been able to finish this task in the dark if need be. I do wonder what would have happened if the Birth Center and skilled help were not here.
I was awake at 4 or 5 am, brilliant stars, crescent moon, bats hunting the veranda just outside my room. Another day, and two more babies born about an hour apart, this time in the morning! One was a first baby for a young mother who had a difficult labor, and I learned a lot from this one. She needed so much support in her early labor, but as the day went on, she settled into surrendering to her pain and by the end, pushed calmly, well, and with focus. The midwives were able to deliver her intact over a very tight perineum. I have to say I was impressed, and I feel honored to be here working with these amazing women.
The second baby is born, again the midwives care for the baby, recover the mother, clean-up, set-up. There is no other staff, so the midwives here do absolutely everything, from labor support to deliveries, to mopping the floor and sterilizing the instruments. At one point during this labor, the midwives were singing.
In spite of almost no sleep, in the afternoon a surprisingly energetic midwife, Miss Nelta, is off walking to do a home visit for a new mom and I am invited to come. We arrive at the compound, down a winding path, up under the trees, little houses clustered, extended family sitting around a cook-fire. Haiti is magic. Lots of smiles, and mom is well, baby is well, Gras a Dye (thanks to God). I fall further in love with the culture of Haiti, and with providing healthcare out on the edge. It’s so very easy to romanticize, life here is a little like camping out- but it’s all the time, and you never get to go home to a hot shower and throwing the laundry into a machine. And as much like Paradise as this can be, the sheer amount of work involved in staying clean and fed is daunting, and there is no safety net when trouble comes- not any, not at all.
Another day off to a nice mellow start at clinic and then an older man arrives to tell the midwives that a young woman has delivered at home without help and the placenta is retained. Of course, they tell him to bring her in right away. About 20 minutes later, two men appear, carrying the woman’s bed with her and baby in it. Yes, that’s right, carrying the bed. I hope she lived close. The midwives quickly clamp and cut the cord and get the placenta delivered in no time, but under the covers with mom is her impossibly small baby- less than a kilo but alive, pink, and breathing- and at least 10 weeks premature. I ask someone to find a plastic bag (protects preemie skin and retains body heat and moisture) and put him under the little gooseneck heat lamp. His temperature is too low to register. I send my translator off to find some hot water and a bottle to put it in, as I am pretty certain that the only source of hot water around here is if a neighbor will heat some up over charcoal or on a propane camp stove.
A bottle is found and the water is wonderfully quick to appear, so I wrap the baby in layers- plastic, blankets, water bottle, more blankets- and hop on into the truck. And I’m thinking we have maybe an hour before he is too tired to breathe, Ann ale (let’s go)! But you have to understand that everyone is inordinately cheerful while all this is going on, and I’m reminded of the legendary “optimistic fatalism” of Haitian culture.
Meanwhile, I’m thinking “oh my God don’t let this baby die in my arms” and determined that there will be no tears today and I absolutely will not cry no matter what happens.
At first it’s easy to count because the baby’s distressed respirations are loud, but as we head down the road, the noise and vibration are so intense I can neither hear nor feel the baby breathing, so I re-wrap him with my stethoscope on his chest and spend the next hour plus rotating the water bottle to different spots and listening continuously to the baby’s heart and lungs. But it works, and they continue to work, and down the road we go. Now sometimes “road” can be a bit of a euphemism, and in this case it is more like a steep tumble of fist-sized rock, in the good places mixed with sand and loose gravel, in the bad places- under water. But after 45 minutes of that, we hit pavement and now it is a different kind of skill as our intrepid driver, Whiler, makes our way through farm animals, pedestrians, motos, trucks, markets and small towns to the mid-size town where, hallelujah, there is an actual mid-size University Hospital.
The baby is still breathing, the hospital is relatively well-equipped and well-staffed, and the pediatric resident who takes charge of the baby is perfectly recognizable as a pediatric resident. The baby’s blood sugar is now too low to register, but his temp is up to 95 degrees, he’s got humidified oxygen on via nasal cannula, his oxygen saturation is good, and miraculously, he’s got a perfectly good suck reflex and puts away some sugar water nicely while the doc sets up his IV. From here he is into God’s hands and out of ours, but we did what could be done. He was lucky to be born in a place where help and a transport vehicle could be found and he could survive his first day. And if he is very lucky, he will continue to survive and maybe even thrive in the Haiti that his community is trying hard to build.
In my 3 weeks in Haiti, the island was skirted (barely) by three different hurricanes. In my 2 weeks at the birth center, without skilled help at least one mother would have bled to death and at least one baby would have died. As I write this, inside a climate-controlled building, sitting on a great chair, at a brand new computer- in Haiti, life and the work goes on.
–Sharon W. Marie, RN, CPM
Sept, 2017 Cabestor, Haiti,
Midwives For Haiti Volunteer
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Cover image photo: Candace Duran, CNM.