Day 5~ Hospital, NRP, ICU patient, Azul feeding center.
Rise and shine! Yippy its hospital day. I get up and head out to get some coffee and breakfast. A piece of toast and a banana should do. I’m so glad I have brought my powder creamer. It makes my coffee so much better but still not quite as good as id like.
I go back and get my scrubs on. I pack up my fanny pack with many gloves, hand sanitizer, fetal Doppler, US gel, thermometer, alcohol swabs, misoprostol and erythromycin eye ointment. I place other things in my bag that I know I will need for the hospital. I finish getting ready for the day and it’s time to go.
My moto is ready and I hope on. I’m so ready to get to the hospital and start caring for the patients. First thing on the agenda is to check on the ICU mom. Shelly and I go over and she is laying in a weird angle. She is a big, tall woman and you can tell she is heavy. She has edema everywhere. Her heart rate is fast and she is breathing hard. She has brown urine and little of it. Her IV hanging is not dripping and we find out it was hung 10 hours earlier and no one has even checked it. Shelly on I start to do an assessment on her and I start to mention all the things that can be easily fixed or simple things that are being ignored. She needs to be closely watched and assessed every few minutes. We tell them a handful of things to do and we go back to the labor and delivery unit.
We get a feel with what is happening with the patients there. One is having twins and is going to c/section. There are 2 or 3 more in different stages of labor. I find out the basic information on them. What number baby are they having, gestational age, cervical exam, any complications of pregnancy they may be having. One lady has a large belly and they say she is 32 wks. I assess her and totally disagree. But when I tell the midwives they don’t listen. They give her steroids for the baby’s lungs and nifedipine to stop the labor. All it does is slow it down and then she goes back into a regular labor pattern.
After seeing that not much is happening in maternity, we head over to postpartum and assess some patients there. We know that the new twins are born and are awaiting the mom’s arrival to postop. Its taking a long time and we are begging to get worried. She has a boy and a girl. The girls head is shaped strange. I can’t put my finger on it and think maybe she was breech and that caused the strange flat sides. Her face is small though. I decide to check on her the next day.
We spend the next few hours bouncing from ICU, maternity and postpartum. Frequently checking on mom in ICU ensuring that she is getting the care she needs within the capabilities we have in Haiti.
The laboring woman get louder and we know to go back to maternity. The 16-year-old is getting close and the government midwife student is getting set up for her delivery. The have a ‘delivery’ tray full of sterile instruments, bulb syringe and resuscitation equipment. She suddenly is crowning and I happen to have gloves on and prepared. The government student is not. I apply perineal pressure so she doesn’t tear. The student is ready and I let her finish the delivery. Winter goes on the other side of the momma for help. The baby comes out stunned and needs some help to breath. Winter and I do our magic and I can’t help but think, 4 of the students I had just taught NRP to yesterday, are now watching me do it. Luckily for us. Baby comes around quickly and we hand over care to the midwife student.
One of the other woman laboring has had a prior c/section. The doctor comes and evaluates her and says she can deliver vaginally. She has had a vaginally delivery after C-section already so this mean she is a good candidate for it. The doctor tells the midwives to augment her labor with Pitocin. So, they inject into her IV bag. It doesn’t take long and you can watch the ladies labor get more intense. Within an hour she is contracting very frequently and I notice her belly change shape. I instantly think maybe she has had a uterine rupture but she isn’t experiencing extreme pain. I palpate her abdomen and I don’t feel any obvious fetal parts. No students are managing her labor, only a midwife so I offer my help. I see the midwife tell a nursing student to adjust her Pitocin drip faster. I swear within 10 mins that baby was born. No fetal heart tones were listened to for quite some time. The woman quickly delivers what looks like a dead baby covered in think pea soup meconium stained fluid. Everyone in the room gasps because the baby looks dead. I think ‘oh fuck’ and Winter and I start doing our magic. We stim the baby and winter listens for a heart rate, above 60bpm. This is not good news but at least we know we have a chance. After sucking the baby’s mouth and nose really good, we stimulate the baby well and try to get it to breathe. NO luck. I grab the bag and mask and start breathing for the baby. I’m not getting a good seal and I can hear it making noises. I can see some chest rise but I know it’s not the best. I ask Winter to grab the bulb syringe and we suction again. We ask the midwife to please cut the cord. This baby needs to be rushed to the NICU. She cuts the cord, grabs the baby and we hustle to the NICU. We barge in and request assistance. There is still little to no respiratory effort but the NICU nurse asks me to stop bagging the baby. I’m shocked by this. We are at 5 minutes of age and no respiratory effort. This baby is going to die if I stop doing interventions. I do as she asks and step aside. I’m good at NRP. I know I’m good. But I don’t have the same tools here that I do in USA. So, they know their equipment and work with this all the time. The limp, pale baby is laying there as she gets her equipment ready. I see some occasional shallow breaths, maybe 10 per minute. She starts rubbing and stimulating the baby and I just want to yell, ‘we are past that point, give the baby oxygen”!! We are asked to leave as the nurses are very protective of the NICU and don’t like people in there. I later found out the baby was still in the NICU but doing okay. Thank God.
We go back to the maternity ward and help get the mother cleaned up. It’s almost time to go for the day. We head pack to check on ICU mom and the twins’ mom. As we are walking to ICU we see the woman come out of the OR. She has had a postpartum hemorrhage and you can tell by looking at her. I do a quick assessment on her in the post op area and she is severely hypotensive. I start quickly yelling out things I need to save this woman. I think, ‘here I go again, saving a life.’ I give some miso, demand pain medicine, give her another sheet to stay warm as she is hypothermic (imagine that in a hot and humid climate), encourage frequent fundal checks and close observation. When I checked on her later she was doing much better.
After a final check on the ICU mom, it’s time to go. I want to donate blood to the ICU Mom. We walk next door to the Red Cross and I start to fill out the paper work. I can’t donate blood if I’ve had a tattoo in the last 12 months. Well I have but I know my blood is clean. They test it anyways before giving it to anyone. But I want to also be honest. So, I’m totally bummed that I can’t donate. My blood isn’t compatible to the mom but in Haiti you need to give a unit of blood in order to receive a unit of blood. They just don’t give people blood.
We get a moto’s and head back to the house. When we arrive, class is finishing up and it’s time for lunch. Soup with meat, potatoes, carrots and dumplings. It is very good but why soup? It’s extremely hot outside and it’s not the best meal. But, I’m hungry and once its cooled down, I eat it. I make a side of toast for it too. I guess the cooks don’t make fresh squeezed juice when they make soup.
After lunch, Winter and I are scheduled to go to Azul feeding center. It’s a sad place but a much-needed place to go. We arrive just as a rainstorm is starting. We walk through and I lead Winter to the baby room. The workers in there are just finishing up snack time. Some liquid that reminds me of cream of Wheat. We ask to help feed and they point to a baby who hasn’t feed yet. I pick him up and give him the cup. I was so surprised with how hungry he was and how fast he ate it. I tried to stop and let him take a breath as I was holding the cup up to his mouth but he would start to cry and push it back up. He finished it fast and I got him so more but he didn’t eat of that. After, we helped get the babies cleaned up, changed and into their cribs for nap time. At the center, they are not orphans. Just children who have malnourishment. Their families are required to visit twice a week. A baby about 9 months old was crying so Winter picked him up. She tried for some time to settle him down but he kept saying Mamma and looking at the door. I took the baby and tried too. The caregiver was saying something but I didn’t understand but it made me think the mom was either out there or had left. After about 10mins, the mom showed up and took over caring for the baby.
We left the age group and went and played with ages about 4 to 6. These kids just wanted to pick them up and they would crawl up us. It was bit much so we didn’t stay there long.
We left that room and went to the 2-4 age group. Before we entered, we heard a child crying. I wasn’t expecting to see what I saw when I came around that corner. I an extremely burnt baby. Half his face, right had was completely burned down to the muscle and left hand about 50 % burned. Some burns on both arms. You can see its incredibly painful, it has spots of blood on his face. I want to cry. I want to be mad. I want to help and I want to know who, what, when and why! I go and find a nun for answers. She tells me the baby was left at home while his mom went to the market. While she was gone, the baby got into boiling water and she found him this way when she returned. I can’t even imagine how that baby felt when it happened and no one there to help him. The mom can’t afford the hospital so she took him to the feeding center as she knew she wouldn’t be charged. I told the nun I wanted to help. This baby needs pain medication and needs its now. She said the baby was getting meds every 12 hours!!! Are you serious? I told her that wasn’t frequent enough and the baby was being tortured! I would pay for the meds if it was necessary. She told me she would talk to the other nun and she will come find me and let me know.
We went back to the baby and the caregiver had taken him out of his crib. It was covered in dead skin and wet marks from oozing. I sit next to him. I wanted to hold him badly but I don’t want to hurt him. He looks at his hands, back and forth. I pull out a matchbox car and try to hand it to him. I realize he can hold it. So, I push it around near him. Dear God help this baby. I don’t want to leave him but its time to go. As we are leaving, the nun finds me and says thy will be increasing the frequency the baby gets pain meds to every 4 hours. I was so please by this! We thanked the nun and we walked out. Both in silence over the rough day we have had. A burned baby, a dying Mom, saving 2 babies lives. Postpartum hemorrhage. A septic mom in postpartum. It can be so taxing on your soul. I can barely keep it together.
We are to meet out moto outside the feeding center. We wait some time standing outside the centers gate. Many Haitians walk by, some very slowly while staring at us. A woman comes by, stops, stares and then comes over to talk to us. We of course don’t understand her. Winer takes out her phone to try to use a translator app she has. But it isn’t working. I think she trying to tell us someone needs our help. She is having a baby and is sleeping. I decide to call Stecy to use her as a translator, plus our ride is late. Once I get Stecy on the line I ask where the moto is and she said he should be there soon cuz she called him a long time ago. Then I tell her a woman needs to talk to her. Apparently, the woman’s daughter and baby died in childbirth and she is asking for money to bury them. We of course don’t have money for that and I don’t have anything on me. We decline and send our condolences and our moto shows up just in time. Geez, really, can our day please get better not worse! We climb on the moto and head home.
When winter and I arrive back, we are asked to work on the matron kits. We will be handing them out on Friday when we train them at a meeting. It’s a very basic kit. A set of gloves, 2 strings, a small piece of soap, razorblade, 2 gauzes and a paper chux pad. Winter and I are doing them when we decide to go across the street and buy a beer. We head over and the other girls show up and want to go too. We get a beer for our security guard as well and head back to our gate.
Dinner is ready shortly after and we all sit down to eat. A yummy pasta casserole. While we are sitting for dinner, we all start visiting and chatting and we decide to play my ‘Watch your mouth’ game. It was really very funny and we all laughed very hard!!! Love this game and introducing it to people who’ve never played it before. I really needed some comedy relief that night.
Shortly after we are done, we head to bed. The typical nightly routine, pills, oils and blogging. I pack up my bag for the hospital tomorrow because I don’t want to worry about it tomorrow morning.
Fan blowing in my face to stay cool and off to sleep I go.
