Our time in Hinche
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.