Day 6~ Hospital, home visits and making matron kits.
Up and at it. I get up and head out to the kitchen for coffee and breakfast. After I have woken up and had a couple cups of coffee, I head back to the room and get ready. Before long, its 8am and time to get on the moto and head to the hospital. I grab my bag, a bottle water and go.
When we arrive, we drop off our bags and head straight to the ICU. The nursing students are surrounding the patient and talking. I start to do a visual assessment on her. I start to education the students how to care for her. Things to look out for. Like blood clots in her legs and lungs. While telling the students the warning signs, I start to realize the patient is NOT moving her right side and is drooling from the right side as well. I say oh shit, she’s had a stroke. I start to ask her to move her right side, lift her arms, squeeze my hand smile, show me your teeth etc. Her right side is completely immobile. She can’t swallow. I just start to tear up. The students all looking at me. They don’t even fucking get it. She has 7 kids and now she can’t even care for herself and those kids will suffer and some may die. Without their mother, they can’t live. Someone else would have to care for them. If she can’t swallow, she can’t eat. Now it would’ve been better for her to die than to starve to death. In Haiti, they don’t do the necessary thing we do in the US to help a patient who’s suffered a stroke. With the students watching me, I beg them to care for this woman properly. She needs frequent checks, every 15 or 30 minutes. Positon change every 30 minutes. Don’t let her drink before a doctor can assess her as she can choke, aspirate and die. I am so pissed off. This is that horrible doctors fault. She probably had an ischemic stroke when she had an extremely critically low Hematocrit of 3 or so causing hypoxia to the brain. No oxygen being cared by the hemoglobin to the brain. Absolutely horrific. Everyone is quiet. NO one knows what to say. The woman can barely talk because her mouth and tongue aren’t working. But she sure can hear what we are saying. I can’t imagine what she is thinking or how scared she may be,
We check her labs. Her hemoglobin is 3 and hematocrit 9 AFTER one blood transfusion. I can’t even imagine what it was before that and how this woman is still alive. HOW? I just can’t wrap my mind around it.
We head back to the labor ward and there are busy. A woman just delivered and 2 more were in labor. One on the end is HIV positive so I am warned to be careful while caring for her. Another has a huge belly and I ask if she is having twins. The midwife says no but I am having a hard time believing that.
After getting information on the patients, I just sit back and watch. I offer help, suggestions, and occasionally do some patient care. I young girl comes in and I’m asked to get her vitals and check her cervix. I start to do it and Isabella, my interpreter, tells me that patient is nearly impossible to check. She had come last night and she wouldn’t let anyone check her cervix. I talk to her and tell her what I’m doing. Instructed her to take some deep breaths and relax. Every time I get close and it’s time to insert my fingers, she slams her legs close and won’t let me. She is 17. Pregnancy has been the result of rape. A common tragedy in Haiti. I try a couple more times, but it’s not happening. She is preterm and we really need to determine. The doctor comes in and puts gloves on. The midwifes ask me to help the hold her down. I grab her hand and help hold her while the doctor checks. In hindsight now, I wish I wouldn’t have been a part of that. She was very traumatized by that. I’m the one that while stand out though. I’m the white girl near her face. And I feel horrible about that now.
She is 4-5 cm and not having regular contractions. They send her to the antepartum unit for now to wait and watch. I continue to watch the other ladies laboring. It’s not long before the woman on the end is getting ready to deliver. The skilled birth attendant student will be doing the delivery with her preceptor overlooking her. I offer her one of the paper gowns that I have brought from home. She is the kind of patient they should be preparing themselves for and protecting not only themselves but other patients.
There is a dirty bed from the previous delivery needing cleaning. The bed is covered in blood and the housekeeper comes over with a bucket and rag. She wipes away the blood, turns over the rag and washes the rest of the bed. Never rinses the rag and just keeps wiping. She is done and I can’t even imagine the amount of blood on that bed. The next patient is there and waiting for her to wash it. She has been outside making a lot of noise, waiting for a bed. I actually place gloves on outside and follow her because I think she is going to deliver outside.
Once the bed is ready she climbs on it. I do an immediate assessment on her. Vital signs, fetal heart tones and then I’m ready to do a cervical exam. As I’m getting gloves on, I look over and the baby is starting to come. We tell the midwife and she starts to grab what she needs. This patient hasn’t even been in here 5 minutes. The baby is delivered and I stand by to help the midwife with drying and stimulating the baby. He came out so fast, he was a but stunned but by 1 minute he was breathing and starting to cry. After the placenta, the mom has some increased bleeding. The midwife does a fundal check but she isn’t very aggressive about it. I try not to get involved but after the 2nd trickle of blood, I know from experience that the patient has clot that needs to be expressed. I go over and do a proper fundal check and firmly press down. A large amount of blood and clots come out and the midwife looks surprised. I tell her that she needs to be aggressive when she sees that kind of bleeding. Especially on a mom who just had her 4th baby.
I want a few minutes and check again. More bleeding but no clots. We get some miso ready to give but when she checks the fundus again it’s okay. She we hold off. She doesn’t have an IV since she delivered quickly. She received Pitocin IM right at delivery. Another check by me shows another heavy bleed. I tell the midwife she should give the miso and if that doesn’t work she needs to start an IV and do IV Pitocin. She gives the miso and we wait, I check off and on. Some times its okay and other times it’s a moderate amount. I let the midwife do the management of the patient and give my attention to the ICU mom.
We walk in and ask if the doctor has been by to see her yet, no. We go and find the doctor and ask for him to assess her. A while later he comes in and I tell him she has had a stroke. This is the same doctor that pulled the babies out and caused this big issue. He has a confused looked on his face when my translator tells him. He is in disbelief. I show him, he assesses her and says it’s a temporary thing and she will be okay. I surely hope so, for her sake. I can barely look at him. He is disgusting, a horrible person.
We check in on the postpartum unit. I want to see the patients I cared for yesterday. While there, I see everyone and they are all well. We are asked to help assess a mom and baby. I do the full assessment on both and give the mom some bp medication. We hear some moms in the labor unit and go back.
The mom who looks like she is having twins has been checked and the doctor has order Pitocin augmentation. She has moments where some contractions are intense and others she doesn’t even make any noise.
A 19year old comes in and needs a D and C. She has taken illegal miso to induce an abortion. The doctor is going to do the D and C right there. He starts to set up and I question why this isn’t being down under anesthesia. Isabella say some do it that way and some don’t. I think this poor girl is about to be tortured. I watch as the do all the skin prep and he inserts a speculum exam. No one is giving this girl any support so I step up to her and take her hand. This is going to be incredibly painful and she will need a hand to hold. He inserts some lidocaine inside, I’m guessing around her cervix. She screams out in pain. He can’t really see what he is doing so I offer him my headlight and eye shield.
He inserts more lidocaine and she is crying. I hold both her hands and help to keep her from climbing up the bed away from him. The whole procedure took about 30 minutes. I stood there while she sobbed and screamed in pain. If I wasn’t there, I’m sure no one would’ve given her any compassionate care. I hope she appreciated what I did. There was no way to know. Maybe I wasn’t helpful to her. Maybe she was glad I was there. I don’t know.
There was a little boy, age 7, who had diphtheria in the ICU Monday and then died on Tuesday. I haven’t had my vaccine in a few years. So, we told everyone who was in the ICU they needed to be vaccinated. I will update mine when I get home. I feel sad when I hear that he didn’t make it and think of my own sons. The pain his parents must be experiencing. An everyday thing here, preventable deaths. My patients sometimes refuse medications, vaccinations etc. Some that Haitians would walk hours or go days without eating just to be able to purchase them. It’s hard to watch when you know some Americans are refusing these much-recommended medications.
Time quickly approaches 2pm and its time to go home for lunch. Isabella calls me a moto and once it arrives she says goodbye and goes home. I arrive home to a busy house with students leaving and instructors are all around. Lunch is ready, rice, beans and a meat dish. Fresh limeade. Not much time to relax because Winter and I are sent out to do home visits with Kelby.
We climb on the moto’s and Kelby takes us to where we are going. It’s confusing because there are no street signs or house numbers. How does someone know where to go? It’s crazy. Turn left at the chickens and then an immediate right at the garbage pile. Lol.
We are riding along when someone yells out at us. It’s the woman and her baby. We stop and turn around and are welcomed. Most are happy we are there and offer us chairs. We pick who is going to check out the baby and who will check out the mom. I decide on the new baby. Both check out great and the baby is gaining a lot of weight. I give big sister a bracelet I made and then we say our thanks for graciously allowing us to assess them. Kelby calls the next house and we are ready to go. We arrive at a very poor home. The mother is 2 weeks postpartum with a c/section and had been readmitted to the hospital with a fever. She complains of pain in her lower abdomen and she has not felt well. Her vital signs are normal but when I look at her incision it is infected. Yellow pus and the incision is open. Her baby is doing well but breastfeeding is a concern. I urge the mother to go to the hospital but she isn’t able to. She is depressed as her pregnancy was twins and one of the baby died. She is unable to leave today so I clean her wound and instruct her and her husband how to do it and how to care for it. She can go to the hospital tomorrow. I give her some pain medicine to take as well. We watch the baby latch on and offer any suggestions we see that may be needed. There are a few children standing by. As usual, we always draw a crowd wherever we go. I hand one of the boys a car and the girl a bracelet. Then I ask if I can have a picture of them. They agreed and I took a picture and then shoed them it. They are so shy at first, Haitian kids. But once you engage with them, they want to hold your hand, play with your hair, ask about your tattoos and be your best friend. I love these children here in Haiti.
We have one more stop to go to. A newborn just a couple days old. Standard postpartum home visit. It’s extremely important that we visit these families. MFH has found many, many complications and have saved lives with this new program. We get back on the moto’s and Kelby takes us to where we need to go. A man is waiting for us in the general area and we get off the moto’s and follow him behind some buildings. We walk past some Haitians doing their hair and up to the woman’s porch. Another tiny house, about the size of a small bedroom, but it has carpet laid down so we remove our shoes. Winter remembers her from the prenatal clinic. Both her and the baby are doing well and we assess them both. No problems for either of them except she has elevated blood pressure. She has been given meds but she doesn’t like to take them because they make her sleepy. We think she is becoming hypotensive but we can’t tell her to stop taking them. We instruct for her to follow up with the clinic soon. I have a small bag with some shampoo, conditioner, soap, granola bar and a shirt. I give it to the mother and tell her what to use it for…. all through the translator Kelby.
We are down and head back to the house. Dinner will be waiting for us. A robust soup, beef (or goat), carrots, potato’s and a rich, thick soup base. Delicious. I have a piece of toast with it too. We have matron kits we need to finish making for tomorrows matron training. So, we all sit down and do about 50 of them in about 20 minutes. I enjoy making them, it’s so simple but so needed. After making the kits, I take a much-needed cold shower. The water isn’t heater. Even though it is shocking at first, it feels good after a while.
After my shower, I pack my bag for the morning. We get to sleep in because we don’t leave until 9am. We are all looking forward to that. Slowly, we are retiring to our beds. I’m always the last one up, getting caught up on my blog. I’m about 2 days behind and I would like to get caught up. I also don’t want to miss or forget anything so I like to add detail. Sometimes I don’t go into as my detail as I would like because I am so behind.
I take my malerone, place on a lot of oils, plug my phone in to charge and turn the computer off.
Good night Haiti.
