a GRAND opening in Hinche...

Today was the first day of the new Midwives for Haiti Post-Natal out patient follow up clinic on the grounds of Hopital Ste Therese. Illa did follow up visits and Jusline did mom/baby assessments hospital discharges.

After intensive discharge teaching all week, especially about "early milk" and encouraging moms to breastfeed fequently, drink plenty of water and eat a variety of healthy foods....drummroll...

ALL of the babies had LESS than 10% wt loss and MOST of them were already ABOVE their birth weight!

The mom's were all recovering well too.

Juslene also shared that over the weekend she had an inpatient mom that she saw before discharge and upon her postnatal assessment found the baby had a fever. Rather than just walking out the door 6 hours after delivery...never to be seen again, a possible infection was identified & her baby was referred to the Pediatric unit for early treatment.

HIGHLIGHT:

Two of our opening day patients are nurse graduates of Midwives for Haiti's Skilled Birth Attendant program. They not only had colleagues deliver their babies in the hospital, but now they're receving postnatal care follow up from former classmates & new co-workers as well.

It made for a lively FIRST day!

Gotta love any work day that includes a moment like this...!

Pauline's Beautiful Baby GIRL

Ivanese's GORGEOUS Baby Boy

Goal met: the 3 H's

Happy Healthy Haitian Mom's & Babies!!

Ministry Projects: Maternity Care

While I wish that I had ALL of the details to share on this current project in development, what I DO have to share is quite exciting!

For several years I have been in communication off & on with Nadene Brunck, the founder of Midwives for Haiti. Initially it was for imformation I needed on a mock up midwifery care grant-writing project for a course I was taking at the time. Over the past year she has been a wise voice on my journey into maternity care here as well as my plans for midwifery school, which God willing I'll begin in the fall.

While I had already hoped to meet up with her while she was in Haiti this past month, the circumstances took a turn. We arrived in Hinche without the list of specific questions that I had in mind and instead just absorbed our experiences at the local hospital where MFH provides clinical experience to their students. We soaked up rural life in Haiti and we talked about all that we had on our hearts and then listened to Nadene and her co-workers do the same. It was more information than we could process in 2 days, but we've kept the line of communication open on how we might work together and bring more Haitian babies into this world safely and keep their moms healthy & alive to care for them.

Last week a great opportunity rose to the surface & Nadene & I began discussing my taking leadership of a project that her organization just can't get to at the moment. 

Opening & managing...A BIRTHING CENTER!!

Hopital Albert Schweitzer (HAS) is located up north in Deschapelles. It has been providing care and saving lives in the Artibonite Valley for nearly 60 years.

While it is a project still being "hatched", the idea is that our ministry will partner with HAS & Midwives for Haiti (MFH) to start a free-standing birthing center on their campus compound. While they do already provide maternity care, it is more than they can handle. They have been asking MFH to do open this center, as they would like to move all of the low risk births there for the skilled birth attendants to provide care & focus on hihg risk maternity cases in the hospital. They would also like to have a MFH training program at their location eventually.

While I DREAM of starting community birthing centers throughout the country, I couldn't ASK for a more nurturing situation to learn and grow and gain my first birthing center administrative experience in, while I attend school. 

The birthing center will be staffed by two nurses with obstetrical specialty that have recently graduated from MFH's World Health Organization approved skilled birth attendant training program. I will pitch in with supportive patient care when I am onsite & the rest of the time oversee the details of operation.

We are hoping to get things moving by summer, so watch for more news on this upcoming project & details on the many ways that you can help support it!

KNOWN Ministry/Project NEEDS:

I AM currently looking for MIDWIVES, L&D, Mother/Baby and NICU RN's who might be interested in working in Haiti either for a short -term trip, or partnering with us as long-term ministry field staff. 

I am ALSO looking for a clinical site in the U.S. to complete my CNM skills requirements in 2016. It does seem early, but the school recommends finding a clinical site and preceptor before you even begin!

Again, thank you for your interest & support of the work that God has laid out before us-

Rebecca 

a visit to Midwives for Haiti

Tuesday afternoon Ted, I & Hugo packed it up to get out of the city for a couple of days. We picked up Jenna Schmitz, the education coordinator for Midwives for Haiti & three of her friends, Sam, Jordan & Mary who are global health fellows working in a remote medical center in Thomasique, Haiti, who were all returning from a long hike through the mountains from Furcy to Jacmel. We had a pleasant 3 hour drive through the plush farmland up north to the homebase of MFH in Hinche.

It was fun & new to be with a vibrant group of young people all working in the medical field here & sharing dinner with the resident staff of MFH. Part of the plan was just to learn more about the organization first hand, to get to finally meet face to face with Nadene Brunck the founder and also to tour the local facilities where they teach their skilled birth attendants kind compassionate, quality, hands on care. I also hope to return & provide preceptorship for the new class of midwives late this spring & wanted an idea of what it would be like beforehand.

photo: MFH

We had great conversation & I was intrigued by a firsthand look at the rural Haitian hospital setting and the scope of care. There is a group from Ohio State, currently working alongside the pediatric nursing staff, to develop better neonatal care for preemies & high risk infants. We enjoyed visiting the bedside of day old preemie twins as the American RN modeled and explained necessary care of the little ones for her Haitian nurse counterpart.

photo: MFH

The disparity of care here in Haiti vs the US, where I’ve recently practiced, struck me solidly. We helped examine the mother of the twins, who had a vertical abdominal incision as well as a small unrepaired episiotomy from the birth of her babies. I watched as her mother changed the saturated rags that took the place of the nicely wrapped fresh white disposable peripads that I handed out to my patients these past few months. Patients or their families bring all of their own care items, including food. I could actually see that working in the US where my family would bring all of the best for me & yet we have each necessity included. Here in impoverished rural Haiti, there wasn’t much to choose from for families to provide.

photo: MFH

On Thursday morning Ted & I took a small hike on the land behind the MFH compound and went up to the top of the local hills. We shared our personal thoughts & ideas while pondering further where God was taking us next. The view that we had up there struck me as very SYMBOLIC of our current place in life & ministry right now…there were roads leading in EVERY direction around that hillside!

SO MANY roads...which one should we travel? where will it lead us? That prompted us to spend some time in prayer then & there and afterwards we built a small monument of local rocks (a tradition I follow whenever I meet with God in nature) to commemorate our time with Him there.

We drove back to the beauty of the central plateau, soaking up our thoughts & experiences. I’m looking forward to spending this International Women's Day, this Saturday (3/8) further immersed in maternity care at a forum on birthing center development that MFH is hosting in Petionville.

To refreshing skills and BEYOND!!

SWEET blessings to share, regarding my current travel nurse contract...!

While I took it for two main reasons: updating my L&D skills and helping our finances God has been SO GOOD to use it for more…

First, I am enjoying the fact that the hospital is nestled in the neighborhood that I grew up in in Northern California. In fact my mom lives just a few blocks away & I actually was a “candy striper” (for those of you who don’t remember what that means - a student volunteer) at this hospital as a very young teen. I remember wishing that my duties included holding the newborn babies back then, but usually it was running errands for the nurses & clerks. Now here I am delivering & holding babies at the same hospital MANY years later!

Secondly, it has been super rejuvenating to be able to drop in on family after work and on days off to share life together a bit and have the time to catch up from the heart. Driving three of my five kids to drop off work applications, attend interviews, and giving words of encouragement or hugs as needed, especially to my oldest, who has been on her own the past couple of years ALL feeds my soul as much as theirs.

Lastly, the most unexpected blessing has been the professionals that I am working with. The RN’s have been kind, helpful & patient as I’ve had to get up to speed on their computer documentation system. Thankfully, my patient care skills have flowed as if I never stepped away. It has been reaffirming to realize that assisting birth is still a very deep part of who I am!

The DOCTORS that I am working with here have taken this to another whole level though. Somehow, I have been ending up with quite a few “natural” deliveries...I would choose them anyhow, typically, but these have been assigned. The feedback that they have given about my patient care has been a true BOOST! Since this hospital has no midwives on staff I wasn’t sure what to expect as far as learning beyond my current skills. There ARE however a substantial team of female doctors that are very collaborative and “real”. Earlier today, one of them, when I explained that I was paying closer attention to “repairs” since I am preparing for midwifery school in a few months...jumped in & spent her time teaching me EVERYTHING that she was doing and explaining complexities that I won’t go into detail on. I feel like my education has already commenced and that I am SUPER fortunate to have 8 more weeks of this opportunity! Since it is likely that I will be helping deliver babies in Haiti long before my degree is completed, those skills are absolutely priceless...& once again I feel BLESSED!!

Maternity care - a life & DEATH matter

In May, my friend delivered a healthy baby girl by c-section here in Haiti at one of the nicest hospitals that I’ve been to in Port au Prince. She was a lucky one...THIS time. She is 43 years old, has a history of high blood pressure, previous c/s and of a previous neonatal loss. Yes, she “lost” a baby boy the first day after birth, many years ago due to pre-eclampsia and lack of pediatric care where she delivered. This time, she had some health guidance, her own experiences, and a steady job that allowed her to go to a good doctor to follow her very high-risk pregnancy. We searched out the best hospital for her delivery and then had to find a “connection” for her to deliver there. She found one! She went in as soon as her blood pressure began to rise seriously at 35 weeks and stayed on the open bed unit under observation until it was time to deliver. I am SO thankful to God that she had no complications, her c/s went fine & she had a good peds MD for the baby this time...her greatest concern! She now has a gorgeous, thriving 2 month old daughter. 

Although her delivery went well, I’m sure if you are from a first world country, like the US, Canada or Europe...there are still a few differences in her story that might be hard for you to imagine. I know that I was stunned to hear that my friend had lost her only son within a day after birth due to no pediatrician being available for newborn care.  

Did you also catch the hint that she had to have a “connection” in order to be SURE that she could deliver there? There is a strange separation here between prenatal care and delivery. In Haiti, you might see an MD for your whole pregnancy, but they may not be associated to any specific hospital, or maybe only to a very expensive hospital in Petionville that few can afford. So when it comes time for delivery it is up to you to find a place that has “space” for you and that you'll be able to pay for. If you are in labor here and you go to a hospital that is “full” they will not look for another bed to squeeze you in, but turn you away in the streets to find another place to deliver.  Let me just add to that picture the fact that many moms walk miles or ride on tap taps (basically the back of a truck) to get to each hospital...WHILE they are in labor. Let me ADD that if you don’t have the money to pay, they will also turn you away.

My co-worker, Shelley, shared the story of a young Haitian woman that delivered in a local clinic. Someone came running to her to explain that the clinic was “holding the baby hostage” until this woman could pay the bill. Shelley went down there & found the woman lying there in a pool of blood. The caregivers explained that they weren’t going to stitch her up until they knew she could pay the bill. They also didn’t have any sutures or supplies handy. Shelley explains that she had to run to a pharmacy and buy the supplies, pay a fee and THEN they repaired her...stopping before the last stitch to request another $5 to complete the job. Once done they stood her up, placed her baby in her arms and practically shoved her out the door... If Shelley hadn’t been there with a vehicle...she would have gotten on a hot, crowded & bouncy tap tap for her ride home within hours of giving birth.

Another thing that I found different here is the fact that even the very NICE hospital requires sharing an open ward. There were at least 5 beds lined up on a wall on each side of the very clean & efficient maternity unit. If a mom had delivered then there was a clear bassinet at the foot of her bed. If it was twins then there were two crowded in. Each bed had one chair next to it for a visitor/helper. There were no hanging curtains to pull for privacy & the visitor hours were from 10-12 and 3-5pm, strictly enforced except for the one helper. Patients had to bring their own towels/blankets, and if food wasn’t brought to them by family/friends then they didn’t eat. It was a whole new world for me...and THIS is a GREAT hospital here.

I have only heard unimaginable stories of the “free” hospital downtown, from the many communities of Haitian women that I interviewed last year.

Despite a rudimentary understanding of this country...there is one maternity care fact that I will never get used to...DEATH. For the year and a half that I have lived here, EVERY single week I’ve heard a new story about a mom and/or a baby who died in childbirth, after childbirth, or weeks later from an untreated childbirth related complication.

I worked 10 years, full time in a high risk Labor & Delivery unit in Northern California and only faced ONE maternal death on our unit - a situation that was unpreventable. Even then a brave MD delivered her by c/s once we knew she could not be revived and with the help of a NICU staff SAVED her baby boy. ONE mom died...out of thousands of deliveries over the years.

Death permeates the reality of ALL of my Haitian friends.  According to a 2011 UNFPA report on the state of midwifery in Haiti, every Haitian woman that bears children has a 1 in 100 chance of dying in childbirth during her lifetime. Until I moved here those “stories” were merely the basis for a good period novel...in order to set up the plot and tension of a character’s life and explain a missing mother figure away. It is a “nonfiction” reality for me now too...I may lose a Haitian friend to childbirth or mourn alongside over her baby’s death.

The sad thing is...the life-altering, heart wrenching tragedy of the earthquake could not be prevented...BUT needless maternal death in Haiti CAN be stopped with adequate, available care!!!

Apparent Project’s basic mission statement is “to keep families together”...one way that they meet that goal is by addressing the needs of the “social” (poverty) orphan population. Through job creation Haitian moms and dads are able to raise their own children. That is AMAZING and beautiful to see first-hand, especially in a country littered with orphanages and abandoned children.

Pray with us as we seek to help families STAY TOGETHER through other types of prevention as well! In this case...by providing good preventative medical and maternity care and safe deliveries here. While my background of 24 years working in maternal/child health is a great start, this is a DAUNTING task that CANNOT be managed alone! In the short time that we have been on staff God has steadily been increasing His prompting on each of our hearts, that this is a forefront issue to be addressed. He has ALSO been opening doors. We are all excited to see how He will continue to provide and pave the way for this ministry!

For example, Tuesday, Ted & I went to pick up a couple of used twin beds for Tynan and Emma from another family ministering here. They also had an office desk and cupboard set available which we decided to get in faith, with hope that it would be purposed for either the employee health clinic or perhaps a maternity center one day soon. While loading it up I was talking with the seller about some other shelving that he will be selling next month and mentioned in passing that we were hoping to eventually open a maternity & preventative health center. He got very excited to hear about our plans and proceeded to explain that he was opening a preventative health medical clinic in an area outside of Port Au Prince as well. He went on to announce that they had been sent a 40 foot container of donated medical equipment & supplies in order to furnish it. Apparently he received 4-5 of each equipment item, but only has 3 exam rooms to fill. So he immediately offered to GIVE us everything that he has left to set our clinic up! Uhhhmazing PROVISION!! 

As you keep us & the people of Haiti in your thoughts and prayers this week - please continue to lift this potential ministry up. With the door of supplies/equipment that just opened, we are compelled to move forward and meet with others for advice this week. They are already providing maternity care in another area, so their wisdom will be crucial. We will also start on a project proposal as we follow the Lord’s leading. Yesterday a medical team arrived, who will be helping with employee health check ups and hopefully help me make a dent in starting medical charts that I can follow up on.

If anyone knows of a midwife or OB/GYN that would be interested in serving here for a few months...that will be the NEXT door to be opened. Did I mention that we continue to need your prayers? Look HERE for our ministry team prayer & tangible needs update!

For a better understanding of maternity care and midwifery in Haiti...read these first hand stories:

http://www.theworld.org/2011/11/hard-lessons-for-american-midwife-volunteer-in-haiti/

http://rhrealitycheck.org/article/2010/10/01/draft-american-midwife-haiti/

http://www.crudem.org/2011/12/14/haitian-american-nurse-midwife-gives-back-to-hopital-sacre-coeur/

United Nation’s Population Fund. 2011. State of the World’s Midwifery Report - Country Profiles: Haiti. Retrieved from: http://www.unfpa.org/sowmy/resources/docs/country_info/profile/en_Haiti_SoWMy_Profile.pdf