Foreigners who visit often say that they left a little bit of their heart in Haiti. That was definitely my experience and since my first trip, in March of this year, hardly a day has passed without at least a few minutes spent trying to get back. It took 5 months, too many conference calls to count, buckets of sweat and maybe even a few tears, but we made it and after a long two days of travel, when I hit the streets of Port au Prince I felt like I was bringing friends home to visit.
In March, I was a lone ranger—I was nimble and agile—my plans changed by the moment based on need. I learned a lot in a short amount of time. It was intense and I found myself wishing, over and over, that someone had seen what I had seen and done what I had done. I so wanted to share all of the thought s and feelings that I carried around with me for months after I returned, but the experience was inexplicable. Happily, I shared the journey this time around with my colleague and dear friend, Rhonda, and two fantastic FNPs in training, Carol and Rachel. In addition to our core group, Magalie, a Haitian-American nurse, traveled with us and provided translation and Ami and Maria, two home-birth midwives from San Fransisco took on the majority of the midwifery duties. Dina, a film maker, was there to make sure that our story would be told. I had not just a single compatriot but a posse; as the only member of the crew who had been to Haiti before, I became the defacto cruise director.
I’m a “do-er” by nature and though I have taken on leadership roles at various points, I am by no means a born leader. I have a hard time remembering to slow down and explain things; giving everyone else the opportunity to “do”. So, this stint as cruise director was a challenge. I may not have risen to it as gracefully as I had hoped, but everyone lived – and in the end, I am so thankful to have been stretched. It forced me to take a step back and in doing so my view of Haiti, of the Midwives for Haiti program and of midwifery in general, expanded dramatically. It was as though lens of my mind’s eye had been switched to panoramic.
There’s a lot of life happening in Haiti. The everyday joys and heartbreaks of human existence are happening, quite literally, right there in the streets. As an action-oriented girl, I tend to participate. I jump in to the waves and try my best to ride the through the highs and lows as if I’ve been there all along. I focus intently on the specific child that I’m playing with or adult that I’m speaking to– but rarely take notice of the interactions and conversations happening around me. This time around it was different. In order to make sure that my charges were safe and had what they needed, I had to be acutely aware of my surroundings and was able to see the whole ocean. I watched each member of the group lifted and dropped by waves of emotion as they took in the realities of people who had been living in tents for months, young earth quake victims struggling to adapt to missing limbs, starving children being fed by nuns because they were too weak to hold their own cups, and a laboring woman enduring hours of seizures that would have been an “emergency” in the US. It was immense, and frightening, and beautiful, and almost more than I could bear. Had I gone on doing my little bit, I might have missed the gift of seeing the change that happens when lots of little bits are being done all at once in one great big sea of humanity.
During my visit in March, the Midwives for Haiti training program was in transition. The lead teacher was leaving, the junior teacher was taking the lead and an American midwife with the patience of Job was struggling to learn the language and impart to the students the spirit of midwifery. The students were unsure of themselves and their place in the hospital—and frankly, the world. Frustration hung in the air and affected everyone. In contrast, during this visit the only palpable frustration was my own. I felt that I wasn’t doing enough. My time was short and I wanted to be with the Haitian students, but seeing to the needs of my American students was my primary responsibility. I had become very attached to the Haitian students during my trip in March. They told me their stories and I told them mine. They were under stress and we bonded quickly. When I left they asked me when I would return, and though I couldn’t say when, I promised them that I would. Now I was back and I barely had time to say hello. I was disappointed, whether or not they were. But here’s the good news– they didn’t need me to do anything. In the months since my last visit, the teachers Marthonie and Reina had morphed in to poised, self-possessed leaders who were clearly respected and revered by the students. The students had gone from a group of eager but clueless novices to proficient practitioners of midwifery who treat laboring women with kindness and compassion. So, rather than doing anything, I got to play the proud auntie going around telling everyone how wonderful they are. I was, and am, totally overwhelmed by the success. If I hadn’t had the wide angle lens, I might have missed the subtle, but crucial changes that assure me that this program is working! There’s still no running water, and there’s very little electricity, but they’re making midwives here folks and I got to see it!
For me, what it means to be a midwife is something that is ever evolving. It’s been years since it was just about catching babies— but I continue to be surprised by the applicability of midwifery skills to new situations. Haiti is a harsh place. It can make even the most seasoned veteran feel helpless and overwhelmed. Moving past those feelings and coming to a place where you know that you have something to contribute isn’t easy. In the same way that no two women labor the same, each of us who choose to walk alongside the Haitian people, as they do the best they can with what they have, deals with struggle differently. All good midwives know that one of our most unique skills is sitting patiently and doing nothing. That’s always been a tough one for me, but this trip brought home for me how important it is to fight the urge to do something, and instead stand in support as others walk their paths. In the big picture of this trip, I see seven new bits of heart that have been left in Haiti and I hope that I have been a good midwife to my fellow travelers.
It has been a busy week trying to get back on schedule while still thinking about all the events of the past week. I went on this trip with the expectation of getting a first hand look at a country that is struggling to recover from a devastating natural disaster. The people of Haiti and people from all around the world are working side by side in Haiti and are making significant strides at improving the living conditions within Haiti. It was encouraging to see so many people who were working with the Haitian people in the recovery effort and reaffirms my belief that people of different beliefs and cultures can successfully build relationships. It is amazing that even in a difficult situation there were no shortage of smiles and laughter that was shared throughout the week. Where there was a shortage of supplies ingenuity was used to create what was needed at the moment. For example, I seen one healthcare worker make a chair out of cardboard, foam and netting. I am happy to say that although building structures may have crumbled after the earthquake the heart of the Haitian people remains steady.
Today was my final day in Haiti. Getting to the airport from Hinche went fairly smooth, although a few of us had GI upset. But we made it..While on the trip down from the plateau I am struck with images that I will forever carry with me.
First, I am so encouraged by the skill and dedication of the “midwife students or the auxiliare”. Life has not been so easy for these students. I observed a midwife student assisting a birth or catching a healthy baby. It brought me to tears. While at the hospital, it reminded me of wards of the past. But many of those patients were there for diseases that were curable…end stage cervical cancer, as one example. I was so impressed that this is the 3rd class of these students to be graduating. I believe that I saw..teach one person at a time,, make a difference one person at a time at work…
Second, the orphange. I used to think about an orphanage as a place right out of the “Orphan Annie series”. But the work that Maison Fortunate is doing for so many children is awesome. These children were being educated, fed, clothed and provided healthcare by a nurse. This orphanage was a dream of Jean Paul, and his partnership with the diocese of Virginia, and it has truly made the lives of these children more hopeful. The sounds of their laughter and music still fills my ears.
Finally, the trip to view Zammi Lasante was the highlight for me. This medical facility houses an HIV and MDR TB ward, pediatrics, maternity, urgent care, a place where food for malnourished children and work for the Haitian people. The saying, rather than give them fish, teach them to fish, kept resonating in my mind. Environmental issues like clean water, was being addressed and worked on. Organic healthy farming of peanuts was an issue that was currently being worked on.
I leave wishing I could have done more. Each evening Brother Mike, our Xavierist host at Maison Fortunate, would do a “debriefing”. On our last night he reminded us of a discussion we had on the first night in Hinche. His words were, you will find that you get more from Haiti than what you give”. On that first night, I truly did not understand. My thoughts were, they need so much from everyone, and I need to give so much more…But I left knowing what he meant. I bring home the children. The loving eyes, beautiful smiles, and yes, some pain. I am so encouraged to know that many of the children are being cared for. I think about the many children and mothers who might not have had a chance to make it to this life without the help of others. I bring home memories of those less fortunate than me, but I am encouraged that work continues to be done in a way that will sustain their life, not my American way of life, but life the Haitian way
It has been a week of resting and reconnecting and trying to catch up. I have had some time to think about our trip to Haiti. My feelings about the trip are complex. It seems that everywhere we traveled I experienced a very broad range of emotions. I was moved from tearful lows to extreme highs.
Starting outing in Port au Prince I felt shocked when I saw the amount of rubble that was still present. Collapsed buildings with twisted steel rebar were everywhere. It reminded me of the images from Mad Max, only this was real. Rubble was still blocking about half of the roads. Cars, trucks, and motorcycles were darting everywhere, barley missing each other and the pedestrians as they swerved around abandoned cars, pot holes and rubble. Riding anywhere in Port au Prince was like Toads Wild Ride, but amazingly, there were no collisions. It seemed orchestrated and I am elated to have survived.
Of course I knew there were still people living in tents, but I never expected to see the long deep stretches of tent cities. They seemed to go on forever. As we rode by on the streets, I felt like a Peeping Tom. By just looking in the direction of the tents, you could often see people carrying out intimate acts of daily life like bathing. Without trying, I could see into the tents and noticed the few possessions and multiple people sharing small space. Little children darting around near the roads bothered me the most.
At the same time that I was taking this sadness all in, I was blessed to meet amazing people who were selflessly working very hard to restore peace and dignity to the survivors lives. People like Beth, John, Dr. Jen, midwife Joanna, Chris and Beverly who work tirelessly to see to it that these people have good medical care and safe clean places to recover and heal. Beth and Joanna’s beautiful birth center and plan of care for the women of Port au Prince were truly a beacon of hope in this sad place. The birth center and what it stands for was so awesome, I felt very proud to know these two women. Beth and Heartline Ministry have also been active in teaching women to sew. Their plan includes reading and writing so that the women will be able to run a small business for themselves. This education is genius in the fact that once these women finish the program, they will be able to support themselves and their children. This is a heroic plan to break the cycle of poverty and could potentially improve the quality of life for generations to come.
The mountains of Haiti are beautiful but bare. The over harvesting of trees for charcoal has left the soil poor and has a direct impact on growing and feeding ability. As we traveled across Goat Mountain, I started to wonder why I had brought medical supplies to donate. It seemed to me that I should have brought 80 pounds of saplings instead. The contrast between my beautiful, green mountains of Floyd and the denuded mountains of Haiti really illustrated the interconnectedness of the ecological health and the physical and social health of communities.
La Maison Fortune is a safe haven. I was sad to think that 200 boys and 50 girls lived there were orphans. Pretty soon it was evident that they were clean, being educated and were happy. Jean-Louis, Brother Mike and Brother Harry provide a safe and happy home for these children. I was inspired by these strong, good men who have dedicated their lives to helping others.
My time at Azil was the most difficult and touched me the deepest. Seeing so many infants there for malnutrition made me feel incredibly guilty. So much we are given in life depends not on our hard work, but rather where we tumble out on this earth and into whos arms we fall. In other words, I feel that we have very little control over our good or bad fortune. Those of us with good fortune often take credit for achieving the wealth. Just being lucky enough to be born into a family that can feed us is a tremendous head start in this life. The infants of Azil have moms that desperately love and want them, but cannot afford to feed them. Malnutrition rides a fast horse in Haiti and often brings opportunistic illness along with it. I realize that I have been privileged to never see my children go hungry. As sad as this vision was, I know that these are the lucky kids. They will be fed and treated and then returned to their moms. If not for the Missionaries of Charity (Mother Theresa’s group) there would likely be no help at all for these children. I am again inspired by people who dedicate their lives to helping the “least” among us.
During our week in Hinche we were reminded of our mission. One night yielded one maternal death and two still born infants. All tragic, but was unavoidable upon presentation to the hospital. We observed the care of a woman who had seizures eight hours before a c-section could be obtained. Amazingly, the woman delivered her baby vaginally when at last moved to the operating room. I was thrilled and amazed to hear both will recover. My time in the hospital in Hinche showed me what was possible. While supplies and water are scarce, Cara told me of all the progress that was being made. Nadene Brunk’s ingenious plan to reduce high maternal and infant mortality rates by teaching midwifery skills to Haitian women is now in its third year in Hinche. Working with the hospital, other NGO’s, and volunteers, Midwives for Haiti is making an impact both in the hospital and through the use of mobile clinics. The outreach of the mobile clinics will be tremendous. The Midwives for Haiti trained women were professional, compassionate and delivered outstanding care in an environment that would bring me to my knees. Knowing this is just the beginning of this program, excites me. Nadene’s work will touch the lives of so many. As our time with the midwifery students was ending, they started thanking us profusely. I honestly did not give them any real help. I thanked them back and praised all the good work they were doing and told them that I had not done anything for them. They replied “we are thanking you because you care enough to come and stand beside us; you give us the strength and courage to continue on.” I was humbled. These strong beautiful women work so hard and ask so little of us. They make me want to be a better person.
One night I noticed one of the volunteers staying at La Maison Fortune had a copy of The Lorax with her. We are at an orphanage, so many of us have brought childrens clothes, books, and toys. (I brought soccer balls for my son in law) Because this book has been a favorite of mine for years, I am very familiar with the story. While lying in bed awake my last night, I started to think about The Lorax. Suddenly, the book took on two levels of meaning for me. I thought about how the trees that the Lorax tries so desperately to save are intricate to the survival of Haiti. Suddenly, I realize that the trees are both trees and women and children. It hits me. The Lorax is not fictional! The Lorax is alive and well incarnate. If you look close enough at Nadene, Beth, John, Chris, Beverly, Dr. Jen, Midwife Joanna, Brother Mike, Brother Harry, Jean-Louis, Midwives for Haiti volunteers, Missionaries of Charity, Partners in Health, Medishares, and all the other volunteers, I am sure you can get a glimpse of him. I did and the Lorax has left me inspired to do better and be better.
Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”
Dr. Seuss The Lorax
Thanks Frontier School for trusting us and allowing this trip and beautiful partnership.
Tuesday Aug 23, 2010 Moliere our driver took us the 3 hours over curvy, hot dusty mountains to Hinche. Due to the number of us, Cara had to sit in the most unpleasant of spaces for the long ride. We arrived at Maison Fortune, the orphanage at which we would be staying for the duration of our trip. We stayed on the side with 200 boys. Our rooms were clean with single beds. Brother Mike was our kind host. Cara and Rhonda stayed in the upstairs room and Rhonda did not have any bites. We understand the student’s room downstairs did have a broken sink and mosquitoes. All of us used nets, DEET and were taking prophylactic meds. The children were all very nice and the sounds of happy playing children were welcome after seeing the children of Port au Prince. The noise level does not drop until around 11:00 at night. The rooster starts to crow at about 3:00 am so students and faculty need to be prepared with white noise, Ambien, and/or extreme patience.
In the afternoon our group toured the hospital. Upon arrival at the hospital we observed a beautiful delivery by the student midwife. We then split off into groups. Rhonda and Rachel went to postpartum and made rounds with the student midwives and Cara, Magalie, and Carol stayed to work with students in Labor and Delivery. Rhonda and Rachel interviewed patients with the help of a hired translator and saw a patient with a DVT among others. Meanwhile back in L&D, everyone was working with an eclamptic lady and trying to manage her and get her back for a C section. In the end it took over 8 hours to get her back to the OR and she delivered vaginally on the OR table. Clean running water and privacy are rare in the hospital wards. Fortunately, new curtains and dividers are up in L&D to offer laboring moms some privacy. Supplies are also scarce. We learn to always have our own gloves and hand cleaner with us. When we returned to the orphanage a few children visited the clinic for rash, belly ache, or menstrual cramps. Some of us played with the children during down time.
Wed August 24, 2010 Our group went to Azil. This is asylum that is run by the Missionaries of Charity, mother Theresa’s order of nuns. Downstairs there are two wards. One with debilitated men and the other with debilitated women. Brother Mike and the Nuns asked us to assess two patients. One was a child of about 8 years (age is hard to asses due to malnutrition). This child had cyclic fevers, edema in the ankles and scrotum, weakness and was very confused. He had been abandoned under the mango tree for the sisters to care for. They reported that starting TB meds had improved his health and that while he was still confused, he had improved. The other was a well developed 25 year old man who suddenly lost his ability to walk, had scrotal rash and ankle edema. We did an assessment of both but, felt out of our area of expertise. We recommended they have both see a physician asap. The sister’s said that a physician would visit Saturday.
Up stairs at Azil there are rooms with 25-30 infants in cribs. The infants are not active and cry very little. They mostly sit, or lie, and stare. They are here because their moms cannot feed them. Once they are nourished, the hope is to return them to mom. Due to the number of children, it is all the sisters can do to keep them fed and dry. They are fed a mixture of beans and rice that is made into a “mush”. Some are fed from bottles, but the hole in the nipple is so big the little ones strangle. Some little ones are fed from a cup and other little ones hold the cup and drink without help. On our visit we were encouraged to hold them to provide much needed stimulation and human touch. After holding many, we helped feed them. Later, when we returned to the orphanage a few children visit the clinic for care- the complaints re the usual; bellyaches, rashes and headaches.
Thursday August 25, 2010 Rhonda, Rachel, and Magalie travel out to Marmot for mobile prenatal clinic. They helped set up the mobile clinic and observed the team do group prenatal teaching and deliver good care to 28 pregnant women. A strong emphasis in the class was put on nutrition, hygiene and signs of preterm labor and preeclampsia. Prenatal care consisted of BP, Wt, (urine dip stick depending on symptoms and BP), fundal height, MVI’s and iron and when to begin the journey into town for hospital delivery. Hypertensive moms are treated with medications and the midwives know when to refer the patients into the hospital. It was noted by our group that while the midwives gathered great data and had good charts, the charts do not follow the patients to the hospital. Our group will investigate ways to help with information flow.
Cara and Carol stayed at Maison Fortune and worked on gathering and entering statistics on the mobile clinics for Midwives for Haiti. This much needed data will be used to assess use, effectiveness and for grant writing.
In the evening, we met Kirsty Bourret RM from Canada who will be the new in country program director for Midwives for Haiti. She is a lovely woman and will do well. She speaks fluent French and nearly fluent Creole. She will take her new position after the first of the year and will be an excellent contact.
Anytime, we return to the orphanage at least few children visit the clinic for care, medical or more likely, emotional.
Friday August 26, 2010 Cara, Carol, Magalie, Brother Michael, Maria and Ami (CPMs form San Francisco who are also volunteering with Midwives for Haiti) drove out to Cange for a tour of the Zanmi Lasante hospital there. The infectious disease program and feeding programs were impressive.
Rhonda and Rachel visited the Midwives for Haiti students in the hospital and delivered some pelvic models that Magalie donated. The students were finishing up doing case presentations for the week and wanted to debrief over the really bad Tuesday night. Tuesday night the students had a maternal death and two still born infants. All tragic and unavoidable. The frustration and sadness of the students were evident and we offered support and encouragement.
When we return to the orphanage the usual suspects visit the clinic for care.
Saturday August 27, 2010 Moliere our driver again took us the 3 hours over curvy, hot dusty mountains back to PaP. Once again, Cara sat in the most unpleasant of spaces for the long ride. Upon arrival at the airport we waited in the American Airline line that starts outdoors. The line is long and hot. Be sure to have water and time for this.
While waiting in the Airport we meet Evan Lyon M.D and a pediatric resident. Dr. Lyon is a specialist in infectious disease works with PIH. He tells us he will soon have a staff in Hinche at the hospital and is very interested in learning about Frontier School and Midwives for Haiti. He expressed very positive comments about the usefulness of FNP’s and CNM’s in Hinche. He shared contact information and encouraged us to be in contact with him when we come back. We feel he is an amazing resource for us in Hinche. While chatting the pediatric resident and Cara discussed the very difficult cases we had seen and we discovered that Cange has a NICU and will help us get the patients in need transferred. This was new and welcome news that we can share with the hospital and staff. The ped resident also wondered if we could teach “Helping Baby Breathe” classes to the hospital staff and would be willing to work with us on this. As we talked we also discussed Azil and our concern over the formula and feeding schedule. We asked him if there was any way PIH could help with the feeding program at Azil. Dr. Lyon stated that he would make a visit and see if PIH can offer help and the special formula that they use successfully for malnourished children. We told Dr. Lyon about the $100,000.00 grant that Midwives for Haiti had been given by Bon Secours health system, and about the plan to use some money for a well at the hospital.
There is some very positive movement in Hinche (Midwives for Haiti training, Partner in Health’s plan to stay in Hinche, ability to transfer infants to NICU in Cange and a new well for the hospital), but there is a serious lack of information distribution. Networking helps us all help each other. After this encouraging exchange, we caught our flight home. Soon we each plan to post our overall refelction on this amazing trip.
Our group has been without reliable internet connection for most of the time in Hinche so we have not posted. We have all seen and learned so much. We woke up early yesterday morning (thanks roosters!) and made the long dusty trip back to PaP. Our wonderful driver delivered us to the airport and we made it back to Miami last night after 7pm. Rachel headed home and the rest of us had dinner and a shower and went to bed early. Today the rest of us made the final leg home.
We all need to rest and reconnect with our friends and family. We have only been gone a week, but we feel like we have grown and changed. We want to take some time to reflect on Haiti, PaP, Hinche, Midwives for Haiti, volunteers, mobile clinics, orphanages, feeding programs and new friends and alliances. Soon we each plan to post more on what we have learned and how we have grown. We will also add a few photos of the places we have been and of our new friends.
Rhonda, Cara, Carol and Rachel
In true Haitian fashion, the driver who was to be here to take us to Hinche at 8am just called to say that he thinks he’ll be here by 10 or 10:30. I’m going to guess that it will more likely be noon :) So, we thought we’d take advantage of extra time here in Port au Prince where there is ready internet access by posting the run down yesterday’s activities.
The morning was spent catching up with Beth and Jonna the two amazing midwives who run the Heartline maternity center. Around noon we had a short visit with the patients at the hospital, then Carol and Cara went to the UN Logistics base to attend the reproductive health cluster meeting with our interpreter, and new friend Magalie HooChong. The meeting was held in the UNFPA offices and was attended by representatives for various NGOs working on reproductive health issues in the camps and more broadly in the country. A representaive from Zanmi Lasante (ZL), the Haitian partner organization of Partners In Health, gave a presentation about the family planning program that ZL is running here in Port au Prince. The primary issue brought forward was the dramatic increase in pregnancies among those under 15 years old. It became clear that these pregnacies are largely the result of violence and though preventing pregnancy is important, it is not enough, and the heart of the issue is security.
Meanwhile, Rhonda and Rachel traveled with our host here at the guesthouse, Chris, and Dr. Jen, pediatrician from Minnesota who serves as medical director for the Heartline field hospital, to Project Medishare for rehab services. Project Medishare is run by the University of Miami and has been opperating in Haiti for more than 15 years. They were the first medical personel to respond to the earthquake and in the months following the earthquake, Project Medishare opperated the 300 bed critical-care Miami field on the grounds of the airport. In June the project moved to Hospital Bernard Mevs in downtown Port au Prince. Rhonda, Rachel, Chris and Dr. Jen took 4 patients: 1 for wound care on a poorly healing stump, 1 for a prosthetic recheck, 1 for physical therapy on a foot with nerve damage secondary to bilateral tib/fib fractures that went weeks withou, 1 for persistent lower limb edema. While there it became clear that these four were only a few of the MANY earthquake victims recieving services. The injuries included spinal cord injuries, multiple amputations, poorly healing wounds and fractures needing revision. Project Medishare’s volunteers were nothing short of amazing. They enthusiatically provided world-class care with dignity and compassion.
At dinner we all came back to continue to celebrate Amanda who will be going to the US soon to be treated for her brachioplexus injury at Mayo Clinic. It’s hard to imagine what she must be feeling as she prepares for such a life changing experience. She’ll be leaving her home and country for the first time to go to place where she doesn’t speak the language or understand the culture, and will not return for five years. It will be her first plane ride and her first experience with cold weather- her first interaction with the non-Haitian world.
After dinner we said goodbye to all of our new friends; the patients at the hospital, the heartline staff, and the babies. It’s difficult to understand, and impossible to explain, how people we’ve know for such a short time have had such a tremendous impact on each of us. They will be a part of our hearts and minds forever.
Photos from the Birth Center note the Footboard-it is made into a birth stool