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Haiti-My first Medical Mission I'm helping Midwives for Haiti to educate skilled birth attendants. Haiti has the highest mortality rate in the Western Hemisphere. Here is where I will write daily journals of my adventure.

Day 12

HAITI | Wednesday, 23 November 2016 | Views [258]

Day 12-  Hospital Ste Therese.

I am awoken by the girls getting ready. A morning ritual has happened. Donna and Tiffany go to bed earlier than me, usually Donna first. I sit up and blog or mess around on my phone til late at night. So in the morning, the girls wake up earlier than I do. I slowly get up and go out to the kitchen. Coffee is not made yet so I go ahead and make it. I am happy to smell brownies. Danna had made them for breakfast. I am also happy that I still have the powdered creamer that I brought down to Haiti. French vanilla. I can drink coffee black but will try to avoid it at all costs. While the coffee is brewing, I go and pack my bag for the day. I need at least one or two snacks. I don’t know when I will be eating again and may get hungry. A couple granola bars and a bag of cashews. I fill my two water bottles up and grab a couple bags and blankets my Mom made. I put on my scrubs and go pour my coffee. I sip my coffee and chat with the girls while I wake up from the caffeine. After a few minutes, I go and brush my hair and put it in a bun. After my last experience at the hospital, I know that my hair definitely needs to be up. I put on a little makeup. I don’t like my blonde eyelashes. If I don’t wear mascara I don’t look like I have eyelashes. When my coffee is finished, I brush my teeth. I have to be careful how I do that. I can not use the water from the tap. It will make me sick. So I use my bottled water to get my toothbrush wet and put on my toothpaste. I like to get the toothpaste wet and pour a little more water from my bottle over that. When I am done brushing my teeth, I have to rinse with the water from my water bottle.

 

 I put on my fanny pack and take a look at my supply in it. I know I am going to need alot more. Joanne has the key to the supply room. I ask her to open it so I can get what I need. Gloves, sterile and non-sterile, gauze pads, 18g IV catheters, tournequets (they use gloves for tourneqets) and alcohol wipes. These are a hot commidity in the hospital. Nurses usually use them multiple times. With my pack barely able to close, I am ready. Slowly the mototaxis and midwives arrive. Everyone is going somewhere different today. Donna, Shani and I are headed to the hospital with our translators Shelly and Isabella. 

 

We get on the motos and head to the hospital. The morning time is busy on the streets of Hinche. People are all walking with supplies that I assume they are trying to sell somewhere. The ladies carry things on their heads, like they do in Africa. We arrive to the hospital and stop at the entrance. We get off the motos and walk to the maternity unit. We can not go in yet because the cleaning ladies need to clean and it is so small in there we would be in their way. It has a bad smell in there so I am glad they are cleaning. We sit outside the doors for a few minutes and finally decide to go check on the baby. We walk over and the baby skin color looks much better. It isn’t as jaundiced as before. She has a little more tone today. Unfortunately, she is still posturing. It is sad to see that. It may be a sign she has brain damage. She is still hooked

up to the IV fluids Emily bought. She is laying on one of the blankets that my Mom made that I gave her. So happy to see that. We are told that she has started to eat a little of her Mom’s breastmilk. We had brought her a manual pump so her family could help her pump and then bring it to the baby to feed it. 

I ask Shelly to find out what her bilirubin lab results were. She asks the nurse and the nurse looks in the file. The baby was never drawn. Despite all that I did to ensure that it was drawn, it didn’t happen. So we will never really know what her bilirubin levels were at the peak of all of this. I am so upset and disappointed by this. If this happened at the hospital I work at, it would be a pretty big deal! They don’t even bat an eye at it. ‘Oh we will have the lab come draw it now.’ Why, what’s the point now? I try really hard not to let my disappointment show, but Isabella and Shelly tell me how upset they are about it. 

We go to check on the Mom. We find out she is in the shower and we decide we will come back later to check on her. Her Mom tells us though that she is feeling much better. 

We walk back over to the maternity unit and they are still cleaning. They are very slow! We decide to go check in on postpartum. We were able to help someone last time in postpartum and maybe we can do it again. We ask the nurse midwife what we can do to help. She tells us to do vital signs on a few of the babies. I go to a Mom and baby who delivered in the night by cesarean section. I do vital signs on the baby and she is okay. I notice though while I am doing them that the Mom has a very productive cough. I tell her via Isabella that it is important to hold her abdomen and do a good cough every 30 minutes. I demonstrate how to do that. I also encourage her to do some deep breathing. If she doesn’t, I warn her she could get pneumonia. I touch her and she feels warm. I decide to do an assessment on her. I take my stethoscope off my neck and listen to her lungs. They are very moist sounding. She likely already has pneumonia. She has a fever of 37.8 and is tachycardic. I ask Isabella to inform the nurse of my concerns. She said the patient came into the hospital with a fever and cough. When I was doing her assessment, the midwife was giving her some postop antibiotics. I encouraged the midwife to let the doctor know of my concerns for pneumonia and she needs antibiotics if the ones she is on don’t cover the pneumonia. I don’t know if she ever did, because I never went back. I sure hope she did.

We walk out of the postpartum unit and head over to maternity. We can finally go in. We walk into the midwives little area and set our things down. I place my water in the fridge. I know after Monday that I am going to want a cold drink while I am here. I go and see what is going on in labor and delivery. There are two laboring women. One is having her first baby and is 6cm and they other has had a baby before and is 6cm.The midwife that is on seems busy. She also acts like the three of us may be in her way. I ask a few times if there is anything I can do to help? I listen to fetal heart beat with the doppler and do vital signs. I try to get a feel for what is going on with the patients. Their age, hematocrit, sexually transmitted infections and any other information I can get. After a while, Shani is working with one patient and Donna is working with the other. I just support each one and offer help. Donna’s patient is having her first baby, is now 9 cm and we believe the baby to be sunny side up. Donna tries different positions to get baby to move.  The midwife injected some pitocin into her IV bag to help. It took alot of TLC and even dodging vomit, but she finally went to  10 cm. It is time to push. She isn’t a very good pusher and requires alot of coaching. She likes to just do a quick grunt push once or twice per contraction and then she stops. Between the midwife, the patients sister, the translator, Donna and I ,she finally starts to push the right way. We listen to the baby’s heart beat every 15 minutes. The baby is doing well except for one time. We listened and the heartbeat was in the 90’s. It slowly came back up. The midwife rolled the clamp on the IV bag to stop the infusion of pitocin. She then goes and gets another bag and spikes it.  At one point the patient is begging us, she can’t do it anymore. This is pretty common when women are close to delivering. Her sister told her she had to do it or she would die. Donna and I were far from thinking that but it is a reality in Haiti. Women die everyday from childbirth. The baby is moving down appropriately now that she is pushing correctly. Delivery will be soon. We have gloves on. Continuously. Our hands are a wet, sweaty mess. We don’t know what the patients HIV status is and you can’t be too careful. The midwife comes and gets ready for the delivery. The baby is crowning and very close to be being born. I listen to the heart beat and it is in the 80-90’s. The midwife tells Shelly to call the doctor. Within a minute he shows up, places gloves on and gives her an episiotomy. No local anesthetic given. The poor girl wasn’t even warned about what was happening. He just came in and did it. The baby easily delivers afterward with her cord wrapped around her foot. No big deal, it is a common thing to have the cord wrapped around something, but that may explain to bradycardia. 

He places the baby on the Mom’s tummy and she instantly looks at Donna and I and said ’thank you so much. I love you. I will love you forever.’ I truly think that she thought she was going to die if it weren’t for Donna and I. We know that that is not true, everything would’ve been fine. Donna and I are very touched by her kinds words of appreciation. I start to cry because Donna and I made a difference for this young girl and I know that she will never forget us. The obstetrician leaves and the midwife delivers the placenta. She then walks away. Pitocin is given in her thigh. I noticed when the placenta was coming out that she has some increase in bleeding. It is normal to have that happen as the placenta detaches from the uterus. But this seemed a little more than what is normal. Once the placenta is out, we determine the bleeding is coming from the episiotomy. It is bleeding heavily. But the midwife had walked away. I tell Shelly to let her know that the patient is bleeding. This needs to be sutured ASAP. The midwife didn’t seem as concerned about it as I was so I took matters into my own hands. I grabbed some sterile gauze and apply pressure to the incision. It hurts the patient and I sympathetically apologize. I soon need to use more gauze. After a few minutes, I didn’t have to apply pressure anymore and the bleeding slowed down. It didn’t stop but it slowed down. 

The midwife finally comes over and tells us what sutures she wants. She asks Shani if she wants to do the suturing and she declines. She offers her assistance though. She uses her flashlight on her phone so they can see better. Soon, the patient is all sutured up and we clean her off.  I go and get her one of my Mom’s blanket and bags. I have the baby and place a pink headband my Mom bought on her head. I have Shelly translate and tell her that my Mom had made these for women like her who were having their babies. She said merci, thank you. Sometimes when I look into a patient’s eyes, I can feel what they are feeling. I could feel her gratitude, it was a magical, special moment.

Shortly after we are done with her, Shani’s patient is ready to deliver too. She had earlier begged us to give her a cesarean section because nothing was happening. She needed her water broke, was stuck at 6 cm. They didn’t want to do that because they didn’t know her HIV status. The midwife injected pitocin into her IV the same time she did it for the other patient. The OB came and broke her water soon after and she was 10cm quickly. She pushed a couple

times and the head came out and stopped right as the chin came out. It looks like she may have a shoulder dystocia. Shani is on one side and I am on the other. We push her legs way back to open up her pelvis. The midwife pulls on the head at a downward angle to get the shoulder to come. It slowly comes and no dystocia happens. The baby is placed on the Mom’s abdomen. I walk away and leave Shani to do the rest. The doctor does her suturing and they clean her up. 

 

We are at the hospital longer than normal. We missed lunch at the house, when it was time to leave for lunch, both of the patients were delivering. We grab our stuff and the interpreters walk us out. There is a 16 year old girl with her baby with us. She is HIV positive and was kicked out of the orphanage. She is asking for MFH to help her. Joanne had gotten involved earlier and had called the orphanage to find out what the story was. I never heard what the story was but Joanne said she needed to go back there. MFH was giving her a ride. Hope everything worked out for her. 

Isabella calls for the mototaxis. While we wait we grab something to drink and a snack. I get a 7up and coconut flavored cookies. They are yummy! The moto’s arrive and we get a ride back to the house. Lunch is waiting for us. Salad, rice and meat with sauce. After we eat, we sit around and hang out. Our laundry had been washed for the day and was hanging on the clothesline. I am blogging or messing around on my phone. The others are either reading or on their phones. It starts to thunder and soon it rains. It pours actually. We quickly grab all the clothes and lay them over chairs and things so they can dry. I need them dry so I can wear some of it tomorrow. After we were already wet, Tiffany went out into it and enjoyed to rain falling on her. Fun site to see. Not long and dinner is ready. It is our favorite so far. Cheesy shell noodles with peppers. Nummy. Shani is not quite feeling well. Her tummy is upset so she doesn’t eat much. She soon has massive diarrhea. She comes in and says she has food poisoning. I can not believe this. What is happening that is making us sick? We are so very careful with what we eat and drink. She soon goes to bed.

Before long, one by one we get into our beds. Donna is usually first. I take my malarone and put on my essential oils. I lay out all of my clothes for tomorrow so I am ready and don’t have to rush. I fill my two water bottles up and place one in the freezer and the other in the fridge. That way they will be cold. I climb into my net covered bed and have the laptop and phone with me. My skin so soft spray is in there and I will put it on before I go to sleep. I try to get caught up on my blog. I can only do a little at a time because typing gets tiring. I play on my phone and eventually get sleepy enough to close my eyes. The fan is blowing in my face and I fall asleep.

Tags: hospital, raining, ste. therese

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